Treatment-Resistant Depression Program

The Department of Psychiatry has been at the forefront of research on treatment-resistant depression (TRD), aimed at understanding its biological origins and developing novel treatments to reduce severity and mortality.

The World Health Organization cites depression as the “leading cause of disability worldwide,” and an estimated 6.7 percent of U.S. adults in a given year experience major depressive disorder (MDD). Current approaches to managing MDD include a lot of trial and error. Physicians often have to experiment with multiple medications in a variety of dosages and combinations before finding a course that works for these patients. Studies show that more than one in three patients with MDD fails to respond to two or more antidepressant trials—in other words, they have treatment-resistant depression (TRD).

Helping patients with TRD requires a specialized approach, and the first step is to confirm that TRD is the correct diagnosis. Incorrect diagnoses occur frequently in individuals who present with symptoms of TRD due to multiple factors including antidepressants of inadequate dose or duration, undiagnosed bipolar disorder, undiagnosed medical conditions (including nutritional deficiency, hypothyroidism, obstructive sleep apnea, or state of systemic inflammation), or undiagnosed personality disorder.

Our Approach to Evaluating TRD

To more effectively formulate treatment recommendations, our team has created a TRD-specific evaluation approach that includes 1) a systematic assessment of past and current symptoms, 2) a systematic assessment of past and current treatments, 3) the use of diagnostic instruments and rating scales, and 4) laboratory, genetic, and brain imaging assessments as appropriate.

Our TRD Treatment Options

If a patient has a preference for a particular treatment modality, our team will direct them to the provider in charge of that modality to assess suitability. Otherwise, the below options are possible components of the final treatment plan.

Esketamine
We are very excited to be the first major academic medical institution in New York City to offer the recently approved SPRAVATO™ (esketamine) CIII Nasal Spray. For information about the drug, visit its website. To read about the role of Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean, Icahn School of Medicine at Mount Sinai, and President for Academic Affairs, Mount Sinai Health System, in inventing it, read the press release

Repetitive Transcranial Magnetic Stimulation (rTMS)
We are now offering rTMS to round out our other neuromodulation offerings (see below). rTMS is a noninvasive way of using magnetic fields to stimulate parts of the brain, and is approved by the Food and Drug Administration for treatment of depression. 

Other Neuromodulation Treatments
We collaborate closely with neuromodulation clinical and research groups at Mount Sinai. Neuromodulation involves stimulating certain areas of the brain to change the circuits that are behaving abnormally and causing psychiatric conditions.

  • Electroconvulsive therapy (ECT): Mount Sinai has a well-established inpatient and outpatient ECT service, headed by Amy Aloysi, MD, MPH. ECT uses an electrical current to create a seizure in the brain that relieves symptoms of depression. 
  • Deep brain stimulation (DBS): DBS involves implanting a pacemaker-like device that sends electricity through electrodes to specific areas in the brain. For more information, check out The Nash Family Center for Advanced Circuit Therapeutics.

Intensive Medication Management, Therapy, and Other Treatments
Clinicians affiliated with our program use a range of evidence-based treatments with an emphasis on personalized care, including medications, individual cognitive behavioral therapy, intensive outpatient therapy, and group therapy.