In the second installment of their landmark series, the National Network of Depression Centers (NNDC) Task Group deepens the conversation on developing effective care for treatment-resistant depression (TRD) with Part II: Assessment, published in the Journal of Clinical Psychiatry. Following the practical and logistical insights provided in Part I, this consensus statement focuses on designing a rigorous, evidence-informed, and patient-centered assessment process at the heart of any successful TRD consultation program.
Why Assessment Matters in TRD
Treatment-resistant depression affects nearly one-third of individuals with major depressive disorder, bringing with it severe personal, social, and economic consequences. Given the complex, multi-faceted nature of TRD, a one-size-fits-all approach to diagnosis and treatment does not suffice. This is where specialized consultation clinics offer advanced assessments to personalize treatment paths and improve patient outcomes.
Core Goals of the TRD Assessment
The NNDC Task Group outlines three primary goals for TRD assessment:
- Clarify the Nature of Illness – TRD assessments must go beyond surface-level symptoms to identify the primary diagnosis and any relevant comorbidities. This includes differentiating between unipolar and bipolar depression, uncovering psychotic features, and evaluating medical contributors such as metabolic or endocrine disorders.
- Establish Realistic and Individualized Treatment Goals – The consultation process should align patient and clinician expectations, focusing on symptom relief and functional recovery in areas like employment, relationships, and overall quality of life.
- Identify Personalized Treatment Options – The assessment should culminate in concrete, actionable recommendations based on the patient’s past treatment history, potential barriers to care, and personal characteristics.
Building the Assessment Package
The Task Group recommends a multi-pronged assessment strategy that includes:
- Comprehensive Treatment History—This includes detailed records on medications, psychotherapies, side effects, and patient adherence, collected through self-report, medical records, and collateral information.
- Expert Clinical Interviews – Conducted by experienced clinicians to develop a biopsychosocial formulation and uncover key psychological factors impacting prior treatment.
- Semi-structured Diagnostic Tools – Tools like the SCID or MINI can enhance diagnostic reliability and uncover overlooked comorbidities.
- Self-Report Instruments – Brief, psychometrically sound measures can serve as symptom baselines and guide follow-up probing during interviews.
- Laboratory and Medical Tests—including thyroid panels, inflammatory markers, and cognitive assessments to screen for medical contributors to depressive symptoms.
Implementation Considerations
Assessment workflows must be adapted to the clinic’s structure and resources. The NNDC recommends:
- Pre-visit screening tools via electronic or paper methods.
- Early collection of medical and pharmacy records.
- Division of assessments among psychiatrists, psychologists, and care navigators to maximize accuracy and depth.
- An estimated 60–90 minutes of direct physician-patient time, with more comprehensive models involving up to 4 hours of evaluation across disciplines.
Looking Ahead: Future Tools and Innovations
Although still experimental, promising developments include:
- Neuroimaging and EEG to uncover depression biotypes.
- Pharmacogenomics for more tailored medication strategies.
- Ecological Momentary Assessment (EMA) and smartphone passive sensing to track real-time symptom patterns.
A Framework for Personalized Psychiatry
As co-author Dr. João de Quevedo of the UTHealth Houston Center for Interventional Psychiatry and his colleagues emphasize, high-quality TRD care begins with high-quality assessment. This second consensus statement equips clinics with the tools and rationale to ensure no dimension of a patient’s experience is overlooked. Together with Part I, it serves as a roadmap to elevate care for some of the most challenging cases in modern psychiatry.
Reference:
Fournier JC, Voytenko VL, Docherty AR, et al. Developing a treatment-resistant depression consultation program, part II: assessment. J Clin Psychiatry. 2025;86(2):24cs15336. https://doi.org/10.4088/JCP.24cs15336
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