Managing Treatment-Resistant Depression

Priyam K. Mithawala, PharmD, BCPS; Daijah M. Davis, PharmD Candidate 2022


US Pharmacist. 2020;45(5):15-20. 

In This Article

Abstract and Introduction


Treatment-resistant depression (TRD) is a growing area of discussion among researchers and medical professionals. Varying resistance levels among patients with TRD pose difficulties in determining an effective treatment for individual patients. Currently, only a few treatment options are approved with an indication for TRD; therefore, current treatment recommendations include restructured oral therapy regimens, psychotherapy, and other options. The alternative of continuous switching and/or combining of antidepressants requires extensive patient education and counseling on proper administration and potential side effects. The use of guidelines and individual patient response are key factors in finding an optimal treatment approach and effectively managing TRD.


Depression can transpire at any time of life because of various causative factors, regardless of individual characteristics such as age, background, and sex. Although there are no definitive causes, patients with a first-degree relative who has a diagnosis of major depressive disorder (MDD) are two to three times more likely to be diagnosed as well.[1] MDD is a common mental-health condition that alters a person's quality of life, with severe symptoms adversely affecting thoughts, feelings, and interest in usual activities, such as eating or working. A clinical diagnosis of depression requires that symptoms persist daily for at least 2 weeks. There are several categories of depression, including persistent, postpartum, psychotic, seasonal, and resistant depression.[2] It is estimated that nearly 25% of people will have an inadequate response to depression therapy, meaning that they are treatment-resistant.[3]