Contributors
HARSH K. TRIVEDI, MD, MBA (Source: The Psychiatric Clinics of North America)
Source: The Psychiatric Clinics of North America - May 5, 2023 Category: Psychiatry Source Type: research

Contents
Manish Kumar Jha and Madhukar H. Trivedi (Source: The Psychiatric Clinics of North America)
Source: The Psychiatric Clinics of North America - May 5, 2023 Category: Psychiatry Source Type: research

Forthcoming Issues
Women's Mental Health (Source: The Psychiatric Clinics of North America)
Source: The Psychiatric Clinics of North America - May 5, 2023 Category: Psychiatry Source Type: research

Women's mental health and lessons learnt from the COVID-19 pandemic
Women are at the highest risk of COVID-19 pandemic adversities as they represent the majority of health and frontline workers in addition to their essential roles et home. We will review specific situations such as pregnancy, women's mental health, COVID-19 disease and gender differences, women health care professionals and gendered violence. We will also review the impact of the pandemic in Africa and the Middle East on women from a developing countries experience. Women mental health care service stands out as an essential component of the national response to pandemics. Women ’s participation and leadership in pandemi...
Source: The Psychiatric Clinics of North America - April 18, 2023 Category: Psychiatry Authors: Florence Thibaut, Gihan El Nahas Source Type: research

Treatment-Resistant Late-Life Depression
This article serves as an evidence-base d guide for medical practitioners who encounter TRLLD in their practice. (Source: The Psychiatric Clinics of North America)
Source: The Psychiatric Clinics of North America - March 27, 2023 Category: Psychiatry Authors: Subha Subramanian, Hanadi A. Oughli, Marie Anne Gebara, Ben Julian A. Palanca, Eric J. Lenze Source Type: research

Approach to Diagnosis and Management of Treatment-Resistant Depression
Major depressive disorder is a chronic and recurrent illness that affects 20% of adults during their lifetime and is one of the leading causes of suicide in the United States. A systematic measurement-based care approach is the essential first step in the diagnosis and management of treatment-resistant depression (TRD) by promptly identifying individuals with depression and avoiding delays in treatment initiation. As comorbidities may be associated with poorer outcomes to commonly used antidepressants and increase risk of drug-drug interactions, their recognition and treatment is an essential component of management of TRD...
Source: The Psychiatric Clinics of North America - March 27, 2023 Category: Psychiatry Authors: Karina Rikhani, Collin Vas, Manish Kumar Jha Source Type: research

Improving Identification and Treatment Outcomes of Treatment-Resistant Depression Through Measurement-Based Care
Measurement-based care (MBC) is the systematic screening and ongoing assessment of symptoms, side effects, and adherence to adjust treatments as needed based on these factors. Studies show MBC leads to improved outcomes for depression and treatment-resistant depression (TRD). In fact, MBC may reduce the chances of developing TRD, as it leads to optimized treatment strategies based on symptom changes and compliance. There are many rating scales available for monitoring depressive symptoms, side effects, and adherence. These rating scales can be used in a variety of clinical settings to help guide treatment decisions, includ...
Source: The Psychiatric Clinics of North America - March 26, 2023 Category: Psychiatry Authors: Taryn L. Mayes, Amber E. Deane, Hayley Aramburu, Kush Yagnik, Madhukar H. Trivedi Source Type: research

Role of Psychedelics in Treatment-Resistant Depression
There is increasing interest in exploring the therapeutic potential of psychedelics in treatment-resistant depression (TRD). Classic psychedelics (such as psilocybin, LSD, ayahuasca/DMT), and atypical psychedelics (such as ketamine) have been studied in TRD. The evidence for the classic psychedelics TRD is limited at the present time; early studies however show promising results. There is also recognition that psychedelic research may be subject to a “hype bubble” at the present time. Future studies focused on delineating necessary ingredients of psychedelic treatments and the neurobiological basis of their effects, wi...
Source: The Psychiatric Clinics of North America - March 26, 2023 Category: Psychiatry Authors: Shubham Kamal, Manish Kumar Jha, Rajiv Radhakrishnan Source Type: research

Brain Features of Treatment-Resistant Depression
Increased awareness of the growing disease burden of treatment resistant depression (TRD), in combination with technological advances in MRI, affords the unique opportunity to research biomarkers that characterize TRD. We provide a narrative review of MRI studies investigating brain features associated with treatment-resistance and treatment outcome in those with TRD. Despite heterogeneity in methods and outcomes, relatively consistent findings include reduced gray matter volume in cortical regions and reduced white matter structural integrity in those with TRD. Alterations in resting state functional connectivity of the d...
Source: The Psychiatric Clinics of North America - March 26, 2023 Category: Psychiatry Authors: Mora M. Grehl, Sara Hameed, James W. Murrough Source Type: research

Pharmacotherapy for Treatment-Resistant Depression
Treatment-resistant depression (TRD) affects one in three patients with major depressive disorder and is associated with increased risk of all-cause mortality. Studies of real-world practices suggest that antidepressant monotherapy continues to be the most widely used treatment after inadequate response to a first-line treatment. However, rates of remission with antidepressants in TRD are suboptimal. Atypical antipsychotics are the most widely studied augmentation agent and aripiprazole, brexpiprazole, cariprazine, quetiapine extended-release, and olanzapine-fluoxetine combination are approved for depression. Benefits of u...
Source: The Psychiatric Clinics of North America - March 26, 2023 Category: Psychiatry Authors: Collin Vas, Ayush Jain, Mili Trivedi, Manish Kumar Jha, Sanjay J. Mathew Source Type: research

Photobiomodulation
Major depressive disorder (MDD) is considered a global crisis. Conventional treatments for MDD consist of pharmacotherapy and psychotherapy, although a significant number of patients with depression respond poorly to conventional treatments and are diagnosed with treatment-resistant depression (TRD). Transcranial photobiomodulation (t-PBM) therapy uses near-infrared light, delivered transcranially, to modulate the brain cortex. The aim of this review was to revisit the antidepressant effects of t-PBM, with a special emphasis on individuals with TRD. A search on PubMed and ClinicalTrials.gov tracked clinical studies using t...
Source: The Psychiatric Clinics of North America - March 26, 2023 Category: Psychiatry Authors: Willians Fernando Vieira, Dan V. Iosifescu, Kayla Marie McEachern, Maia Gersten, Paolo Cassano Source Type: research

Noninvasive Brain Stimulation Techniques for Treatment-Resistant Depression
This article summarizes the mechanism of action, evidence of clinical efficacy, and the clinical aspects of this intervention, including patient evaluation, stimulation parameters selection, and safety considerations. Transcranial direct current stimulation is another neuromodulation treatment for depression; although promising, the technique is not currently approved for clinical use in the United States. The final section outlines the open challenges and future directions of the field. (Source: The Psychiatric Clinics of North America)
Source: The Psychiatric Clinics of North America - March 15, 2023 Category: Psychiatry Authors: Andrea Boscutti, Juliana Mendonca De Figueiredo, Dana Razouq, Nicholas Murphy, Raymond Cho, Sudhakar Selvaraj Source Type: research

The Role of Psychotherapy in the Management of Treatment-Resistant Depression
This article reviews the role of psychotherapy in management of treatment-resistant depression (TRD). Meta-analyses of randomized trials show that psychotherapy has a positive therapeutic benefit in TRD. There is less evidence that one type of psychotherapy approach is superior to another. However, more trials have examined cognitive-based therapies than other forms of psychotherapy. Also reviewed is the potential combination of psychotherapy modalities and medication/somatic therapies as an approach to TRD. There is significant interest in ways that psychotherapy modalities could be combined with medication/somatic therap...
Source: The Psychiatric Clinics of North America - March 15, 2023 Category: Psychiatry Authors: Taylor Rogan, Samuel T. Wilkinson Source Type: research

Special Populations
This article reviews historical work, recent literature on classification, current evidence-based approaches, and emerging interventional research. (Source: The Psychiatric Clinics of North America)
Source: The Psychiatric Clinics of North America - March 15, 2023 Category: Psychiatry Authors: Emine Rabia Ayvaci, Paul E. Croarkin Source Type: research

Pharmacotherapy
Ketamine and esketamine have rapid-onset antidepressant effects and may be considered for the management of treatment-resistant depression. Intranasal esketamine has regulatory approval in the United States and European Union. Intravenous ketamine is often administered off-label as an antidepressant, though no standard operating procedures exist. Repeated administrations and the use of a concurrent standard antidepressant may maintain antidepressant effects of ketamine/esketamine. Possible adverse effects of ketamine and esketamine include psychiatric, cardiovascular, neurologic and genitourinary effects, and the potential...
Source: The Psychiatric Clinics of North America - March 10, 2023 Category: Psychiatry Authors: Anna Feeney, George I. Papakostas Source Type: research