Treatment-Resistant Depression

Treatment-resistant depression (TRD) refers to major depressive illness that has not adequately responded to standard treatments, typically including at least two well-conducted trials of antidepressant medications and/or evidence-based psychotherapy. TRD is common, disabling, and associated with substantial personal, social, and medical burden.

Patients with TRD often experience:

  • Persistent depressive symptoms despite multiple treatments
  • Recurrent or chronic episodes of depression
  • Significant functional impairment in work, relationships, or daily activities
  • Increased risk of suicidality and hospitalization
  • Limited tolerance to medications or adverse treatment effects

Our Approach to Treatment-Resistant Depression

At the UTHealth Houston Center for Interventional Psychiatry, TRD is addressed through a comprehensive, matched-care model that emphasizes timely access to effective treatments and individualized clinical decision-making. Each patient undergoes a thorough evaluation to clarify the diagnosis, assess the adequacy of prior therapy, and determine the most appropriate level and modality of care.

The Center’s Treatment-Resistant Depression (TRD) Program serves as the flagship clinical pathway for patients with refractory depressive illness and provides coordinated care across:

  • Outpatient services
  • Intensive Outpatient Program (IOP)
  • Partial Hospitalization Program (PHP)
  • Inpatient psychiatric care

Treatment Options

Treatment for TRD may include a combination of:

  • Medication optimization, including augmentation strategies and, when appropriate, pharmacogenetic testing
  • Evidence-based psychotherapy, delivered in individual and group formats
  • Interventional and neuromodulation therapies, including:
    • Intranasal Esketamine Therapy (SPRAVATO®)
    • Intravenous Ketamine Therapy
    • Transcranial Magnetic Stimulation (TMS)
    • Electroconvulsive Therapy (ECT)
    • Other advanced interventions, when clinically indicated

Symptom severity, illness course, safety considerations, prior responses, and patient preferences guide treatment selection. Care plans are reviewed collaboratively with patients and adjusted over time based on response and evolving clinical needs.

Continuity and Outcomes

Patients with TRD may transition between levels of care as needed, with an emphasis on continuity, relapse prevention, and long-term recovery. The Center uses measurement-based approaches to monitor outcomes and inform ongoing treatment decisions.

Through this integrated model, the Center aims to reduce delays in effective treatment and improve outcomes for individuals living with treatment-resistant depression.