Treatment-Resistant Depression (TRD) Program

The Treatment-Resistant Depression (TRD) Program at the UTHealth Houston Center for Interventional Psychiatry is a comprehensive, multidisciplinary program dedicated to the care of individuals with severe, chronic, and treatment-resistant depressive illness. The Program serves as the Center’s flagship clinical pathway, integrating advanced diagnostics, matched levels of care, and state-of-the-art interventional treatments within a unified model.

The TRD Program was designed to address a critical gap in psychiatric care: patients whose depression persists despite multiple evidence-based treatments and who often experience profound functional impairment, recurrent hospitalizations, and elevated suicide risk.

Program Philosophy and Model of Care

The TRD Program is built on a matched-care framework, rather than a rigid stepwise approach. Each patient undergoes a comprehensive evaluation to determine:

  • Diagnostic clarity and illness complexity
  • Severity, chronicity, and functional impact of symptoms
  • Prior treatment adequacy and response
  • Safety considerations and urgency of intervention

Based on this assessment, patients are matched to the most appropriate level of care and treatment modality, with the flexibility to move across levels as clinical needs evolve.

The Program’s overarching goal is to deliver the proper treatment, at the right intensity, at the right time.

Continuum of Care

The TRD Program spans the full continuum of psychiatric care, including:

  • Outpatient TRD Clinic, for specialized consultation, medication optimization, and interventional treatments
  • TRD Intensive Outpatient Program (IOP), for patients requiring structured, frequent care
  • TRD Partial Hospitalization Program (PHP), for patients with significant symptom burden and functional impairment
  • TRD Inpatient Care, provided on DCB 4C at the John S. Dunn Behavioral Sciences Center, for patients with acute safety concerns or severe illness

Transitions between levels of care are intentional, coordinated, and guided by ongoing clinical assessment and outcomes monitoring.

Interventional Treatment Integration

A defining feature of the TRD Program is its integration of interventional and neuromodulation-based treatments, delivered within a comprehensive psychiatric framework rather than as standalone services. Available interventions include:

  • Electroconvulsive Therapy (ECT)
  • Transcranial Magnetic Stimulation (TMS)
  • Intranasal Esketamine Therapy (SPRAVATO®)
  • Intravenous Ketamine Therapy
  • Magnetic Seizure Therapy (MST)
  • Vagus Nerve Stimulation (VNS)
  • Deep Brain Stimulation (DBS)

Treatment selection is individualized, evidence-based, and guided by shared decision-making.

Measurement-Based and Longitudinal Care

The TRD Program emphasizes measurement-based care to monitor symptom severity, functional outcomes, and treatment response over time. This approach supports:

  • Early identification of non-response
  • Timely adjustment of treatment strategies
  • Structured relapse and recurrence prevention

Care is longitudinal, recognizing that treatment-resistant depression is often a chronic and relapsing condition requiring sustained engagement and follow-up.

Education, Research, and Innovation

In addition to clinical care, the TRD Program plays a central role in the Center’s mission of education and research. The Program supports:

  • Training of residents, fellows, and visiting scholars in interventional psychiatry
  • Clinical research aimed at improving outcomes and refining treatment selection
  • National and international collaboration in the study of treatment-resistant mood disorders

Program Mission

Through this integrated model, the TRD Program seeks to transform care for individuals with treatment-resistant depression, with the aspiration to become for depression what comprehensive cancer centers are for oncology: a destination for specialized expertise, advanced treatment, and sustained recovery.