A Roadmap for Treatment-Resistant Depression Programs
As rates of depression continue to climb worldwide, a new consensus paper offers much-needed guidance for health centers seeking to launch specialized consultation programs for treatment-resistant depression (TRD).
Published by a task group from the National Network of Depression Centers (NNDC), this article outlines essential recommendations for creating and maintaining TRD consultation services in academic medical settings. Co-authored by leading clinicians and researchers, including Drs. Vitaliy Voytenko, Susan Conroy, and João Quevedo, among others, the document serves as a practical blueprint for institutions seeking to improve outcomes in one of the most challenging areas of psychiatry.
Why TRD Consultation Programs Matter
TRD affects about 30% of patients diagnosed with major depressive disorder and often leads to chronic suffering, disability, and increased suicide risk. Despite multiple trials of standard therapies, these individuals experience little or no relief. That’s where TRD consultation programs offer expert, individualized evaluation and treatment roadmaps that can make the difference between prolonged illness and meaningful recovery.
Key Components of a Successful Program
The authors break down their recommendations into several core areas:
1. Systems-Level Planning
Setting up a TRD program requires coordination across psychiatry, business development, IT, and finance departments. A solid business model should account for startup costs, personnel, diagnostics, space, and projected revenue, including both direct patient services and indirect benefits such as downstream interventions (e.g., TMS, ECT, ketamine, or research trials).
2. Equity and Access
Access barriers, including insurance coverage, language barriers, geographic limitations, and stigma, must be addressed. The team emphasizes inclusive referral pathways (not just from psychiatrists), culturally competent staffing, and community outreach — all to ensure TRD care reaches those who need it most.
3. Defining the Target Population
TRD programs should serve adults with unipolar or bipolar depression who have not responded to prior treatments. Patients in acute crisis should be stabilized elsewhere before being transferred. Importantly, being flexible in how TRD is defined allows the program to serve a diverse range of clinical profiles.
4. Streamlined Referral and Intake Process
A designated Intake Coordinator can manage triage, gather outside records, and support patients through logistics and authorization. This enables clinicians to concentrate on high-level evaluation and informed decision-making.
5. Delivering the “Product” of the Consultation
At the heart of the program is a comprehensive, individualized report that includes diagnostic impressions, a biopsychosocial case formulation, and structured treatment recommendations. These recommendations should include next steps, contingencies for non-response, and potential diagnostics — all clearly communicated to the patient and the referring provider.
6. Follow-Up and Quality Monitoring
Post-consultation contact helps ensure continuity and treatment fidelity. Some programs offer follow-up visits to support implementation and track outcomes. This phase also enables data collection for quality improvement and research purposes.
A National Movement Toward Specialized Depression Care
The consensus statement is more than a how-to guide; it signals a shift in how the field approaches complex depression. As more academic centers develop TRD consultation programs, shared standards and collaborative networks, such as the NNDC, will be key to ensuring quality, equity, and innovation.
For institutions seeking to enhance their mental health services, this paper provides a solid foundation for launching high-impact, sustainable TRD consultation programs — programs that can significantly alter the trajectory of patients who have struggled for too long without practical solutions.
Reference:
Voytenko VL, Conroy SK, Docherty AR, et al. Developing a treatment-resistant depression consultation program, part 1: practical and logistical considerations. J Clin Psychiatry. 2025;86(2):24cs15335. https://doi.org/10.4088/JCP.24cs15335
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