Related Experiment Video
Updated: Jan 29, 2026
08:20
MRI-guided dmPFC-rTMS as a Treatment for Treatment-resistant Major Depressive Disorder
Published on: August 11, 2015
14.5K
Next-Step Treatment Options for Treatment-Resistant Depression: Insights From the Mayo Clinic Depression Center Panel
Matheus G Marques1, Aysegul Özerdem1, Simon Kung1
1Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota.
The Journal of Clinical Psychiatry
|January 28, 2026
Summary
Treatment-resistant depression (TRD) lacks a clear definition, complicating care. Expert consensus recommends augmentation with antipsychotics, TMS, or ketamine, tailored to patient factors beyond standard guidelines.
Area of Science:
- Psychiatry
- Clinical Neuroscience
- Pharmacology
Background:
- Treatment-resistant depression (TRD) impacts a significant portion of major depressive disorder patients, increasing morbidity and suicide risk.
- The absence of a standardized definition for TRD complicates treatment selection and prioritization.
- Existing guidelines offer broad treatment categories, with persistent evidence gaps in newer interventions and complex clinical scenarios.
Purpose of the Study:
- To provide a clinical perspective on treatment selection for TRD by modeling a modified Delphi consensus.
- To address the gap in standardized definitions and treatment prioritization for TRD.
- To explore expert opinions on next-step treatment strategies for TRD.
Main Methods:
- A simulated case-based discussion involving 10 psychiatrists specializing in TRD treatment at the Mayo Clinic Depression Center.
- Iterative ranking of next-step treatment options using structured clinical vignettes of TRD patients after three failed antidepressant trials.
- Three anonymous survey rounds with intervening group discussions, incorporating six vignette variations reflecting clinical considerations like metabolic disease and age.
Main Results:
- Strong consensus supported augmentation with second-generation antipsychotics, transcranial magnetic stimulation (TMS), and ketamine/esketamine as initial next-step treatments for TRD.
- Treatment preferences adapted based on patient characteristics, including nonaugmentative antidepressants and electroconvulsive therapy (ECT).
- Expert opinions highlighted the need to tailor TRD strategies beyond conventional guideline tiers.
Conclusions:
- Tailoring treatment strategies for TRD to individual patient factors is crucial for effective care.
- Integrating multidisciplinary perspectives and patient preferences can enhance therapeutic selection in TRD.
- This expert consensus provides valuable insights for personalized care in treatment-resistant depression.
Related Concept Videos
01:05Long-term Depression
33.2K
Long-term depression, or LTD, is one of the ways by which synaptic plasticity—changes in the strength of chemical synapses—can occur in the brain. LTD is the process of synaptic weakening that occurs over time between pre and postsynaptic neuronal connections. The synaptic weakening of LTD works in opposition to synaptic strengthening by long-term potentiation (LTP) and together are the main mechanisms that underlie learning and memory.
33.2K
01:03Long-term Depression
3.3K
Long-term depression, or LTD, is one of the ways by which synaptic plasticity—changes in the strength of chemical synapses—can occur in the brain. LTD is the process of synaptic weakening that occurs over time between pre and postsynaptic neuronal connections. The synaptic weakening of LTD works in opposition to synaptic strengthening by long-term potentiation (LTP) and together are the main mechanisms that underlie learning and memory.
Calcium Ion Concentration Mechanism
If over...
Calcium Ion Concentration Mechanism
If over...
3.3K
03:12Freezing Point Depression and Boiling Point Elevation
39.9K
Boiling Point Elevation
The boiling point of a liquid is the temperature at which its vapor pressure is equal to ambient atmospheric pressure. Since the vapor pressure of a solution is lowered due to the presence of nonvolatile solutes, it stands to reason that the solution’s boiling point will subsequently be increased. Vapor pressure increases with temperature, and so a solution will require a higher temperature than will pure solvent to achieve any given vapor pressure, including one...
The boiling point of a liquid is the temperature at which its vapor pressure is equal to ambient atmospheric pressure. Since the vapor pressure of a solution is lowered due to the presence of nonvolatile solutes, it stands to reason that the solution’s boiling point will subsequently be increased. Vapor pressure increases with temperature, and so a solution will require a higher temperature than will pure solvent to achieve any given vapor pressure, including one...
39.9K
01:28Depressants
418
Depressant drugs, including alcohol and sedative-hypnotics, diminish central nervous system activity by enhancing the action of gamma-aminobutyric acid (GABA), a neurotransmitter that reduces brain activity and promotes relaxation. These substances can have various therapeutic uses but also pose significant risks, especially when misused or combined.
Alcohol is a common depressant that can induce a sense of relaxation and reduced inhibition at low doses. Contrary to its occasional...
Alcohol is a common depressant that can induce a sense of relaxation and reduced inhibition at low doses. Contrary to its occasional...
418
02:56Treatment Resistant Cancers
3.7K
Cancer is the second leading cause of death in the United States. A cancer cell is genetically unstable and hence can mutate faster. They can also modify their microenvironment and escape immune surveillance. The difficulties in treating cancer are further compounded by the emergence of rapid resistance to anticancer drugs. The most common ways to attain resistance in cancer cells include alteration in drug transport and metabolism, modification of drug target, elevated DNA damage response, or...
3.7K
01:18Depression: Overview
871
Depression is a prevalent mental illness marked by persistent sadness and lack of interest in previously enjoyable activities. It can take several forms, including major depression, persistent depressive disorder, and bipolar I and II disorders. Symptoms range from emotional changes like chronic worry to physical changes like sleep disturbances and suicidal thoughts. From a neurobiological perspective, depression is believed to be triggered by abnormalities in the brain's prefrontal cortex,...
871