| Description |
Treatment-resistant depression (TRD) is prevalent in the United States, with 30% of depressed patients not achieving remission with two antidepressant trials. TRD is difficult to treat, and primary care providers often lack adequate guidance to support patients. This State of the Science Review was conducted by searching CINAHL, PubMed, and Google Scholar databases for relevant literature to assess current and emerging treatment strategies for TRD. Pharmacogenetic testing and psychedelic drug therapy, including ketamine, MDMA, and psilocybin, are considered in the management of TRD. Genetic testing can guide the initial selection of pharmacotherapy, increasing the likelihood of remission by 71%. Psychedelic therapies have the potential to reduce depressive symptoms, especially in conjunction with psychotherapy. Ketamine has been approved for the management of TRD and should be considered for patients who have failed current therapies. MDMA and psilocybin have also shown promising therapeutic effects, but their classification as Schedule I controlled substances would require reclassification for medical use. While current therapies are well researched and should be the first line of treatment, practitioners could be doing more by educating patients on novel therapies that have the potential to be life-changing. Further research and participation in clinical trials can expand the options for managing TRD and potentially improve the outcomes of patients struggling to manage TRD. |
