Treatment-Resistant Depression: Identification and Treatment Strategies.

Treatment-resistant depression (TRD) refers to depression that fails to remit after at least two to four medication and psychotherapy treatment strategies. TRD carries significant personal burden and risk for suicide and poses substantial burden to society. Less than 30% of individuals diagnosed with major depressive disorder achieve complete remission of symptoms. Using the evidence-based predictors of TRD in the initial assessment of patients, clinicians can arrive at a treatment plan to improve outcomes. The current article includes first-line medications based on symptom presentation as well as augmentation and more aggressive treatment recommendations for patients who continue to experience depressive symptoms beyond 6 months of effective dose and time trials of treatment. [Journal of Psychosocial Nursing and Mental Health Services, 56(9), 11-15.].