On Demand Grand Rounds: A Systematic Approach to the Management of Difficult-to-Treat Depression

This presentation was originally reviewed on February 2, 2024, and broadcast live online on February 7, 2024, from 12:00 PM – 1:00 PM ET. 

The views and opinions expressed by this presenter in this lecture are their own, and do not represent the views of Sheppard Pratt.

“Treatment resistant depression (TRD)” is defined when a patient’s depression has failed to respond to two consecutive adequate trails of different antidepressants.  This begs the question as to who or what is “resistant”.  TRD focuses on non-response, does not take into account the equally challenging situations of lack of a sustained response or intolerance/contraindication/non-acceptance of treatment.  “Difficult-to-treat depression (DTD)” is an alternative, more clinically orientated, concept of depression with poor outcomes.  It describes depression that continues to cause a burden to the patient despite usual treatment efforts by the clinician.  Most importantly, DTD is associated with a chronic, rather than acute, illness model of care.  Key to this is holistic, individualised, management identifying factors that may contribute to the poor outcome and which may be tractable.  While remission of symptoms is the primary goal of treatment, if this is difficult to achieve, the focus might more appropriately shift towards optimal management of residual symptoms and most importantly improvement in psychosocial functioning and quality of life.  This presentation will discuss how to manage DTD systematically using the DTD model of care to optimize not only symptomatic improvement of patients, but also reducing risks of relapse and maximizing improvements in patient’s quality of life.

Target Audience

This activity is intended for physicians, nurses, psychologists, social workers, counselors and other mental health professionals. 

Learning Objectives

At the conclusion of this activity, attendees will be able to:

  1. Describe the components of the DTD management model.
  2. Demonstrate an ability to review a patient’s pharmacotherapy systematically
  3. Explain the components necessary for an “individualized algorithmic approach” to treatment
Course summary
Available credit: 
  • 1.00 ACEP NBCC clock hours
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Category II credits for Social Workers
  • 1.00 Psychologists
  • 1.00 MNA Contact Hours for Nurses
  • 1.00 Participation
Course opens: 
04/01/2024
Course expires: 
03/30/2026

Sheppard Pratt’s Professional Education Program is pleased to provide Wednesdays at Sheppard Pratt free of charge as a public service to the mental health community.  Your tax-deductible donations will help maintain the outstanding quality of this service. 

Sheppard Pratt is dedicated to improving quality of life through mental health, special education, and addiction services for children, adolescents, adults and older adults.  Our patient-centered treatment approach, combined with our legacy of clinical excellence, sets us apart from other health systems on both a local and national level.  We have been ranked among the nation’s top psychiatric hospitals for 24 consecutive years by U. S. News & World Report.  Founded in 1853 by philanthropist Moses Sheppard, Sheppard Pratt Health System still abides by its Quaker traditions and values.

Sheppard Pratt regularly hosts renowned speakers from across the country at our headquarters in Towson. We provide educational opportunities on subjects including psychiatric disorders, issues of behavioral health, systems-based change, mental and somatic co-morbidities, psychiatric effects on health and health outcomes, advances in neurobiology, and clinical developments in concepts underlying drug treatment of psychiatric disorders. We are accredited by the Accreditation Council of Continuing Medical Education, the Maryland Nurses’ Association, the Maryland Board of Psychology, the Maryland Board of Social Work, and the National Board of Certified Counselors.

Please send your contributions to:

Sheppard Pratt Professional Education Program
Grand Rounds Fund
6501 North Charles Street, Baltimore, Maryland 21204

Professional Education Program: 410.938.4593
Conference Center at Sheppard Pratt: 410.938.3900

This lecture was supported by Grant Number 6H79FG000999-01M001 from SAMHSA. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of SAMHSA. 

About the speaker

Dr. Hamish McAllister-Williams is Professor of Affective Disorders and Senior Research Advisor at Newcastle University, and Deputy Medical Director for Research at the Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK.  He is an elected Fellow of the Royal College of Psychiatrists and of the European College of Neuropsychopharmacology (ECNP), and Director of Education of the British Association for Psychopharmacology (BAP).  His main clinical and research interests are related to the management of difficult-to-treat mood disorders.  He has published over 250 original peer review papers, abstracts, chapters and books

Disclosure Statements

Sheppard Pratt holds the standard that its continuing medical education programs should be free of commercial bias and conflict of interest. In accord with Sheppard Pratt's Disclosure Policy, as well as standards of the Accreditation Council for Continuing Medical Education (ACCME) and the American Medical Association (AMA), all planners, reviewers, speakers and persons in control of content have been asked to disclose any relationship he /she has with any entity producing, marketing, selling, re-selling, or distributing health care goods or services consumed by, or used on, patients, during the past 24 months. All planners, reviewers and speakers have also been asked to disclose any payments accepted for this lecture from any entity besides Sheppard Pratt, and if there will be discussion of any products, services, or off-label uses of product(s) during this presentation.

Hamish McAllister-Williams, PhD, MD, FRCPsych, reports that he is a consultant and speaker for LivaNova. He will be discussing the use of VNS devices and the off-label use of pramipexole for treatment resistant depression in this presentation. All relationships have been mitigated through review. 

Event Planners/Reviewers Disclosures: The following event planners and/or reviewers are reported as having no financial interest, arrangement or affiliation with any entity producing, marketing, selling, re-selling, or distributing health care goods or services consumed by, or used on, patients, during the past 24 months: Todd Peters, MD, Deepak Prabhakar, MD, Elizabeth Ryznar, MD, MSc, Louis Marino, MD, Ehsan Syed, MD, Devi Bhuyan, PsyD, Faith Dickerson, PhD, Carrie Etheridge, LCSW-C, Tom Flis, LCPC, Stacey Garnett, RN, MSN, Stephanie M. Robinson, MSN, RN, PMH-BC, NPD-BC, NE-BC , Heather Billings, RN, Lisa Illum, MLIS, MEd, and Jennifer Tornabene.

Physician Statement: Sheppard Pratt is accredited by The Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.  Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CME activity.  Sheppard Pratt designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurse Statement: Sheppard Pratt is approved as a provider of nursing continuing professional development by the Maryland Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CME activity. This activity provides 1.0 contact hour for nurses.

Psychologist Statement: Sheppard Pratt is authorized by the State Board of Examiners of Psychologists as a sponsor of continuing education. Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CE activity.  Sheppard Pratt designates this educational activity for a maximum of 1.0 contact hour for Psychologists.

Social Worker Statement: Sheppard Pratt is authorized by the Board of Social Work Examiners of Maryland to offer continuing education for Social Workers.  Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CE activity. This activity is approved for 1.0 contact hour in Category II credits for Social Workers.

Counselor Statement:  Sheppard Pratt has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 5098.  Programs that do not qualify for NBCC credit are clearly identified.  Sheppard Pratt is solely responsible for all aspects of the program.  This activity is available for 1.0 NBCC clock hour.

Available Credit

  • 1.00 ACEP NBCC clock hours
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Category II credits for Social Workers
  • 1.00 Psychologists
  • 1.00 MNA Contact Hours for Nurses
  • 1.00 Participation
Please login or register to take this course.

ON DEMAND WEBINAR: FOR BEST RESULTS WATCH USING GOOGLE CHROME

Grand Rounds: A Systematic Approach To The Management Of Difficult-To-Treat Depression

Hamish McAllister-Williams, PhD, MD, FRCPsych,

Professor of Affective Disorders & Senior Research Advisor, Newcastle University

Deputy Medical Director for Research, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust

Tyne, England

Originally reviewed February 2, 2024.
Originally broadcast live February 7, 2024, from 12:00 PM – 1:00 PM ET
Enduring Activity Credit Expiration Date: March 30, 2026

Activity Time: One hour webinar lecture with a 15-minute evaluation process. Total Time: 1:15.

TO EARN CONTINUING EDUCATION CREDIT FOR YOUR ATTENDANCE
On the OVERVIEW or REGISTER/TAKE COURSE tab, select the GREEN RECTANGLE, TAKE COURSE to begin.
Complete the Pretest and select NEXT in the bottom right corner of the screen. Use the NEXT button for best results.
The PowerPoint handout will be available for download.
After downloading the handout, select NEXT to begin and watch the video. 
You may need to select play for the video to begin.
After the video follow the prompts to complete the posttest, evaluation and attestation of credit. 
Once you have completed all the components of the Course Progress bar, the certificate will be immediately downloadable.

FINANCIAL SUPPORT
There is no commercial support for this activity.

Questions? Look at our FAQ’s at https://cme.sheppardpratt.org/content/faq or Email cme@sheppardpratt.org

Required Hardware/software

Optimal System Configuration

Flash Player: Adobe Flash Player 10.1+
Browser: Firefox 3+, Internet Explorer 8.0+, Safari 4.0+, or Google Chrome 7.0+
Operating System: Windows XP+ or Mac OS X 10.4+
Internet Connection: 1 Mbps or higher

Minimum Requirements

Windows PC: 500-MHz Pentium II; Windows XP or higher; 128 MB RAM; Video Card at least 64MB of video memory; Sound Card at least 16-bit; Macromedia Flash Player 10 or higher, audio playback with speakers for programs with video content; Firefox 1.1+, Internet Explorer 7.0+, Safari 1.0+, Google Chrome, or Opera
Macintosh: Mac OS X 10.3 or higher with latest updates installed; 1.83MHz Intel Core Duo or faster; RAM: 128MB or more; Video Card: at least 64MB of video memory; Sound Card: at least 16-bit

Hardware/Software Specifications

This internet-based CME activity is best experienced using Internet Explorer 8+, Mozilla Firefox 3+, Safari 4+. 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, Microsoft PowerPoint, and Windows Media Player.