Sarah Brand

Sarah Brand

Treatment resistant depression at a glance with traditional, first line antidepressant treatments, as well as a review of the evidence behind esketamine, psilocybin and pramipexole.

Kverno KS, Mangano E. Treatment-Resistant Depression: Approaches to Treatment. J Psychosoc Nurs Ment Health Serv. 2021 Sep;59(9):7-11. doi: 10.3928/02793695-20210816-01. Epub 2021 Sep 1. PMID: 34459676.


  • Approximately 30% of people treated for a major depressive episode will not achieve remission after two or more treatment trials of first-line antidepressants and are considered to have treatment-resistant depression (TRD).
  • Odds of remission decrease with every subsequent medication trial, it is important for clinicians to understand the characteristics and risk factors for TRD, subtypes of major depressive disorder that are more likely to be less responsive to first-line anti-depressants, and the available treatment options.


  • While standard and first-line treatments for major depression still play a primary role, many patients do not achieve remission and/or do not receive adequate treatment.
  • Ketamine may fill in the gaps for patients whom do not respond well, or fail to achieve remission with first-line treatments.

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