Treatment resistant depression: what are the options?

Some patients with treatment resistant depression have tried up to 12 antidepressants and waited 10 years before they are seen at specialist centres, a recent press briefing heard. The figures fall far short of targets set out in draft guidance from the National Institute for Health and Care Excellence, which says that all patients who have not responded to two antidepressants should be referred to specialists.1 NICE’s definition would mean that 2.7 million people in the UK have treatment resistant depression (between 10% and 30% of people with depression), an unmanageable number for the NHS’s psychiatric services. Allan Young, honorary consultant at Maudsley and Bethlem Hospitals in south London, told the briefing that though GPs were good at identifying and treating depression, “TRD [treatment resistant depression] is a subgroup—and there isn’t the capacity in secondary mental health teams to deal with this.” So what are GPs supposed to do? The answer it seems is, first, know the options …