Major depression, one of the most common of the serious mental disorders associated with high levels of mortality (suicide, drug overdose, and comorbid medical disorders) and morbidity is relatively difficult to treat. Although 30-50% of patients attain remission after monotherapy treatment with an antidepressant or cognitive-behavior therapy (CBT), the majority of patients do not. It is well established that the longer a patient remain depressed, the greater the the likelihood of a poor outcome – increased treatment resistance, increased risk for catastrophic medical events such as myocardial infarction and stroke, and increased risk for suicide and substance abuse. The absence of any validated predictors of treatment response as exemplified by the failed clinical trials of commercially available pharmacogenomic testing forces clinicians into a “trial and error” approach in which there is little guidance available as to next steps after monotherapy treatment failure. This presentation provides a summary of the available data on next steps in a treatment algorithm that includes: switching to another antidepressant, or augmentation with T3, lithium, pramipexole, another antidepressant (combination therapy), atypical antipsychotics, esketamine, CBT, transcranial magnetic stimulation (TMS), or ECT. Finally, recently approved and novel promising treatment strategies including psilocybin, zuranolone, esmethadone, dextromethorphan + bupropion, ezogabine as well as advanced neuromodulation methods (e.g. Stanford Accelerated Intelligent Neuromodulation Therapy) will be described. After a lag of almost two decades, the antidepressant pipeline is currently quite robust.
Format
Recorded webinar, non-interactive, self-paced distance learning activity.
This presentation was recorded at the American Psychiatric Association Annual Meeting 2023.
Learning Objectives
- Describe the novel agents that are in development for treatment of major depression.
- Understand the latest algorithm in management treatment-resistant depression.
- Understand the relative merits of transcranial magnetic stimulation, electroconvulsive therapy, and psychotherapy in augmenting antidepressant therapy in non responders.
Target Audience
Medical Students, Residents/Fellows, Psychiatrists
Estimated Time to Complete
Estimated Duration: 1.5 hours
Begin Date: November 1, 2024
End Date: November 1, 2027
How to Earn Credit
Participants who wish to earn AMA PRA Category 1 Credit ™ or a certificate of participation may do so by completing all sections of the course including the evaluation. After evaluating the program, course participants will be provided with an opportunity to claim hours of participation and print an official CME certificate (physicians) or certificate of participation (non-physicians) showing the event date and hours earned.
Continuing Education Credit
In support of improving patient care, the American Psychiatric Association is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physicians
The APA designates this enduring activity for a maximum of 1.50 AMA PRA Category 1 Credit ™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Faculty and Planner Disclosures
The American Psychiatric Association adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Medical Education. Any individuals in a position to control the content of a CME activity — including faculty, planners, reviewers or others — are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.
Program Presenters
Program Planners
- Vishal Madaan, MD. Chief of Education and Deputy Medical Director, APA.
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