Psychotropic Management of Treatment Resistant Depression

In the United States and internationally, major depressive disorder (MDD) is one of the top 10 most debilitating illnesses. Moreover, depressive disorders are the most commonly encountered psychiatric conditions that prescribing and medical psychologists face. However, a sizeable portion of patients either do not respond to commonly used medications or only have a partial response. These patients are generally classified as having Treatment Resistant Depression (TRD). Additionally, there appears to be a lack of consensus on the actual definition of TRD. Notwithstanding, TRD is associated with the development of substance use disorders and suicide. Therefore, it is important to understand available treatment options for patients with TRD so that they may enjoy a higher quality of life.

This seminar discusses antidepressants and antidepressant combinations, mood stabilizers, and other medications, as well as emerging/experimental agents and complementary and alternative therapies shown to be helpful for treatment resistant depression. 

In this presentation we will discuss:

1. How various antidepressants and antidepressant combinations can be utilized for treatment resistant depression;
2. How psychotropic medications other than antidepressants can be effectively used in treatment resistant disorders;
3. Emerging/experimental treatments for treatment resistant disorders; and
4. Complementary and alternative therapies that show promise in the psychotropic management of treatment resistant mental disorders.

After attending this intermediate-level program, participants will be able to:

• Discuss how various antidepressants and antidepressant combinations can be utilized for treatment resistant depression.
• List several psychotropic medications other than antidepressants that can be effectively used in treatment resistant depression.
• Discuss emerging/experimental treatment approaches that appear promising for treatment resistant depression.

This program meets APA’s continuing education STANDARD 1.1: Program content focuses on application of psychological assessment and/or intervention methods that have overall consistent and credible empirical support in the contemporary peer reviewed scientific literature beyond those publications and other types of communications devoted primarily to the promotion of the approach.

This program meets APA’s continuing education GOAL 2: Program will enable psychologists to keep pace with the most current scientific evidence regarding assessment, prevention, intervention, and/or education, as well as important relevant legal, statutory, leadership, or regulatory issues.

David Shearer, PhD, MSCP; Prescribing Psychologist

Dr. David Shearer is a clinical and prescribing psychologist for the Department of the Army at Madigan Army Medical Center (MAMC) in the state of Washington. He serves as a core faculty member and Director of Behavioral Sciences for the MAMC family medicine residency. He is responsible for training family medicine residents in behavioral health topics including psychopharmacology and clinical psychology. Dr. Shearer is fully integrated into the family medicine clinics at MAMC as the primary psychopharmacological consultant and prescriber. In addition, he also teaches a year-long psychopharmacology course to psychology doctoral interns as a faculty member of the Department of Behavioral Health at MAMC. Dr. Shearer is the Chair of the Washington State Psychological Association Prescribing Psychology Legislative Taskforce.

Dr. Shearer is currently serving as Member-at-Large on the Division 55 board of directors. He is an adjunct faculty member at Alliant International University in the psychopharmacology program. Dr. Shearer has appointments in the Department of Family Medicine as an assistant professor at the Uniformed University of Health Sciences and as a clinical instructor at the University of Washington. His research, professional interests and publications include understanding and evaluating the combination of psychopharmacology and psychotherapy in the treatment of behavioral health disorders, prescribing psychology in primary care settings, teaching psychopharmacology to psychologists and allied health care providers, and the development of prescribing psychology in the military.

Hägg, Brenner, P., Reutfors, J., Li, G., DiBernardo, A., Bodén, R., & Brandt, L. (2020). A register-based approach to identifying treatment-resistant depression—Comparison with clinical definitions. PloS One, 15(7), e0236434–e0236434. https://doi.org/10.1371/journal.pone.0236434

Ford, Hahn, L., Clarke, P., Gill, S., Carnell, B., & Galletly, C. (2021). A comparison of 15 minute vs 30 minute repetitive transcranial magnetic stimulation sessions for treatment resistant depression – are longer treatment sessions more effective? Journal of Affective Disorders, 282, 974–978. https://doi.org/10.1016/j.jad.2021.01.009

Marcantoni, Akoumba, B. S., Wassef, M., Mayrand, J., Lai, H., Richard-Devantoy, S., & Beauchamp, S. (2020). A systematic review and meta-analysis of the efficacy of intravenous ketamine infusion for treatment resistant depression: January 2009 – January 2019. Journal of Affective Disorders, 277, 831–841. https://doi.org/10.1016/j.jad.2020.09.007

Ng, Kato, T., Han, C., Wang, G., Trivedi, M., Ramesh, V., Shao, D., Gala, S., Narayanan, S., Tan, W., Feng, Y., & Kasper, S. (2019). Definition of treatment-resistant depression – Asia Pacific perspectives. Journal of Affective Disorders, 245, 626–636. https://doi.org/10.1016/j.jad.2018.11.038

Target Audience: Psychologists and doctoral psychology students.

Psychologists. This program, when attended in its entirety, is available for 1.0 continuing education credits. The Chicago School of Professional Psychology is committed to accessibility and non-discrimination in its continuing education activities. The Chicago School of Professional Psychology is also committed to conducting all activities in conformity with the American Psychological Association’s Ethical Principles for Psychologists. Participants are asked to be aware of the need for privacy and confidentiality throughout the program. If program content becomes stressful, participants are encouraged to process these feelings during discussion periods. 

Non Psychologists. Most licensing boards accept Continuing Education Credits sponsored by the American Psychological Association but non-psychologists are recommended to consult with their specific state-licensing board to ensure that APA-sponsored CE is acceptable.

*Participants must attend 100% of the program in order to obtain a Certificate of Attendance.

If participants have special needs, we will attempt to accommodate them. Please address questions, concerns and any complaints to [email protected]. There is no commercial support for this program nor are there any relationships between the CE Sponsor, presenting organization, presenter, program content, research, grants, or other funding that could reasonably be construed as conflicts of interest.