
Module 1: Introduction to Difficult to Treat Depression
This presentation was produced for enduring credit throughout 2024 and originally reviewed on January 17, 2025.
The views and opinions expressed by this presenter in this lecture are their own, and do not represent the views of Sheppard Pratt.
This introductory module forms the foundation for your learning to assess and manage difficult-to-treat depression. The first part describes what depression is and specifically differentiates between the main uses of the word “depression”, which can refer to a symptom, a syndrome, or a diagnosis. The second part defines difficult-to-treat depression, explains why we prefer that concept instead of treatment-resistant depression, and describes the clinical characteristics of that population. The third part outlines the four-step approach to assessing patients with difficult-to-treat depression.
Target Audience
This activity is intended for physicians, nurses, psychologists, and other mental health professionals.
Learning Objectives
At the conclusion of this activity, attendees will be able to:
- Differentiate between depression as a symptom, syndrome, and diagnosis
- Describe the clinical characteristics of difficult-to-treat depression
- Summarize the four-step approach to difficult-to-treat depression
- Reflect on ways to modify your own approach to a patient with difficult-to-treat depression
This course was supported by Grant Numbers 6H79FG000999-01M001 and H79FG000784 from SAMHSA. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of SAMHSA.
About the faculty
Elizabeth Ryznar, MD, MSC is the Director of Medical Education at Sheppard Pratt and a consultation-liaison psychiatrist. She is also part-time Assistant Professor in the Department of Psychiatry and Behavioral Sciences at Johns Hopkins. She completed her medical training at Harvard Medical School, her residency training at McGaw Medical Center of Northwestern University, and her postdoctoral training in medical education at Johns Hopkins. She also obtained a Masters degree in Comparative Social Policy from Oxford University. An experienced medical educator, she co-edited a textbook called Landmark Papers in Psychiatry with Oxford University Press and received local clinical teaching awards. She has multiple peer-reviewed publications on topics like childhood trauma, psychiatric diagnosis, decision-making capacity and mindful teaching, and her article on Functional Coma won best review article of 2021 from the Academy of Consultation-Liaison Psychiatry. She is using her platform as a psychiatrist to raise awareness about the neuropsychiatric harms of climate change and plastics pollution. She writes a monthly “Climate Column” for Maryland Psychiatric Society and is active on the Maryland Psychiatric Society’s Legislative Committee and Maryland Health Professionals for a Healthy Climate.
Lisa Illum, MLIS, M.Ed., is the Professional Education Coordinator for the Center of Professional Education at Sheppard Pratt. She is also the medical librarian and Archivist for Sheppard Pratt. She received her Master’s in Library and Information Science from the University of South Florida and her Masters of Education in Curriculum and Instruction from Western Governors University. Prior to joining Sheppard Pratt, she was the Assistant Librarian at Keiser University’s Fort Myers Campus.
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.
Elizabeth Ryznar, MD, MSC, & Lisa Illum, MLIS, MEd, report that they have no relationships 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. They will not discuss any products, services, or off-label uses 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, Scott Aaronson, MD, Michael C. Hann, MD, MBA, Louis Marino, MD, Devi Bhuyan, PsyD, Faith Dickerson, PhD, Carrie Etheridge, LCSW-C, Tom Flis, LCPC, Paula Bostwick, MSN, RN, CENP, Alfredo Sagisi, DNP, MS, RN, FACHE, Maggie O'Neill MSN, RN, PMH-BC, 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 1.25 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 1.25 contact hours 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 1.25 contact hours for Psychologists.
Available Credit
- 1.25 AMA PRA Category 1 Credit™
- 1.25 Psychologists
- 1.25 MNA Contact Hours for Nurses
- 1.25 Participation
ON DEMAND WEBINAR: FOR BEST RESULTS WATCH USING GOOGLE CHROME
Module 1: Introduction to Difficult to Treat Depression
Elizabeth Ryznar, MD, MSC
Director of Medical Education, Sheppard Pratt
Assistant Professor, Department of Psychiatry and Behavioral Sciences, Johns Hopkins
Baltimore, MD
&
Lisa Illum, MLIS, MEd
Professional Education Coordinator
Sheppard Pratt
Baltimore, MD
Originally reviewed January 17, 2025.
Produced for enduring credit throughout 2024.
Enduring Activity Credit Expiration Date: February 22, 2027.
Activity Time: One hour recorded webinar lecture with a 15-minute evaluation process. Total Time: 1:15
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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.