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ForwardModule 1: Introduction to Difficult to Treat Depression
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.
Module 2: A Case of Misdiagnosis
In this module, you will have the opportunity to assess a patient with suspected difficult-to-treat depression. The first part reinforces the foundational principles you learned in the introductory module: differentiating syndrome from diagnosis and recognizing suspected difficult-to-treat depression. The second part reviews the PRAT approach and then specifically focuses on how to evaluate the psychiatric diagnosis using a review of systems. The third part reviews the clinical features of bipolar disorder, which is an important diagnosis to consider in suspected difficult-to-treat depression.
Module 3: A Case of Treatment Futility
In this module, you will assess a patient with major depressive disorder whose current depressive episode has not remitted despite multiple medication trials. The first part reviews the PRAT approach for suspected difficult-to-treat depression. The second describes the STAR*D trial and its implications for additional medication trials. The third part introduces neuromodulation as a treatment strategy, providing an overview of electroconvulsive therapy, transcranial magnetic stimulation, and vagus nerve stimulation.
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