Major depressive disorder (MDD) is a primary cause of disability in the U.S. and worldwide. Current, commonly utilized treatments are not effective in a substantial group of individuals who may be described as suffering from ‘treatment-resistant depression’ or ‘TRD.’ As a group, these individuals tend to suffer a chronic, more severe course of illness, utilize the majority of health care resources devoted to the treatment of depression, and are at elevated risk for suicide. This presentation will explore and describe critical current topics in the understanding and treatment of TRD.

**This content was captured at the 2019 APA Annual Meeting and may reference information from various sources and terminology from previous editions of the DSM.

**Slide handout not available for this presentation.

Course References

• Murrough JW, Abdallah CG, Mathew SJ. Targeting glutamate signaling in depression: progress and prospects. Nat Rev Drug Discov. 2017 Jul;16(7):472-486.
• Haroon E, Daguanno AW, Woolwine BJ, et al. Antidepressant treatment resistance is associated with increased inflammatory markers in patients with major depressive disorder. Psychoneuroendocrinology. 2018 Sep;95:43-49.
• Graat I, Figee M, Denys D. The application of deep brain stimulation in the treatment of psychiatric disorders. Int Rev Psychiatry. 2017 Apr;29(2):178-190.
• Bergfeld IO, Mantione M, Hoogendoorn ML, et al. Deep Brain Stimulation of the Ventral Anterior Limb of the Internal Capsule for Treatment-Resistant Depression: A Randomized Clinical Trial. JAMA Psychiatry. 2016 May 1;73(5):456-64.
• Joshi SH, Espinoza RT, Pirnia T, et al. Structural Plasticity of the Hippocampus and Amygdala Induced by Electroconvulsive Therapy in Major Depression. Biol Psychiatry. 2016 Feb 15;79(4):282-92.

Learning Objectives

• Describe the major clinical and scientific issues in identifying the etiology of treatment resistant depression, including the role of neurobiological and inflammatory factors
• Identify pharmacotherapeutic approaches to the treatment of treatment resistant depression, and the current state of drug discovery
• Analyze the specific role of inflammation in driving treatment resistant depression and how novel approaches are targeting this system to discover new treatments
• Assess the uses of deep brain stimulation (DBS) and electroconvulsive therapy (ECT) in targeting specific symptoms for the treatment of TRD
• Compare and contrast DBS, ECT, and ketamine in terms of clinical efficacy and mechanisms of action

Target Audience

Psychiatrists, Residents/Fellows

Estimated Time to Complete

Estimated Duration: 60 minutes
Begin Date: November 1, 2020
End Date: November 1, 2023

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 completion date and hours earned. 

Continuing Education Credit

The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. 

The APA designates this enduring CME activity for a maximum of 1 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

Program Presenters

• James Murrough, M.D., PhD., Associate Professor, Psychiatry, Associate Professor, Neuroscience, Mount Sinai Hospital. Disclosures - Consultant: Otsuka, Clexio Biosciences, Boehringer Ingelheim, Sage Therapeutics, FSV7, Allergan, Global Medicine Education (GME), Medavante-Prophase; Other: The Icahn School of Medicine (employer of Dr. Murrough) is named on a patent and has entered into a licensing agreement and will receive payments related to the use of ketamine if it is approved for the treatment of depression. Dr. Murrough is not named on this patent and will not receive any payments.
• Andrew H. Miller, M.D., Professor of Psychiatry and Behavioral Sciences, Vice Chair of Research, Psychiatry and Behavioral Sciences, Emory University School of Medicine. Reports no financial relationships with commercial interests.
• Martijn Figee, M.D., PhD., Associate Professor, Psychiatry, Associate Professor, Neurosurgery, Mount Sinai Hospital. Reports no financial relationships with commercial interests.
• Katherine L. Narr, PhD., Associate Professor, Neurology, Brain Research Institute, UCLA. Reports no financial relationships with commercial interests.

Program Planners

• Tristan Gorrindo, M.D., Director of Education, American Psychiatric Association. Reports no financial relationships with commercial interests.

Accessibility for Participants with Disabilities

The American Psychiatric Association is committed to ensuring accessibility of its website to people with disabilities. If you have trouble accessing any of APA’s online resources, please contact us at 202-559-3900 for assistance.

Technical Requirements

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• Internet Explorer 11+

This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Adobe Acrobat Reader, Microsoft PowerPoint, and Windows Media Player.

Optimal System Configuration:

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