"Diagnostic C-L Psychiatry" for Treatment-resistant Depression TRD's Subsets: A Novel Approach to Manage TRD in Patients with Contributing Comorbid Medical Disorders

While treatment-resistant depression (TRD) is clearly defined in psychiatric literature, the role of contributing comorbid medical conditions in the pathogenesis of TRD is poorly understood and to a large degree underappreciated. In fact, patients with medical conditions and comorbid depression often respond poorly to antidepressant medications. It is also challenging to disentangle underlying medical conditions from depression, and there is no clear method to identify true TRD based on comorbid medical illnesses in the consultation-liaison (CL) literature. CL psychiatrists can play a significant role in filling these gaps, improving diagnoses, and even in some cases changing prognoses with better-designed interventions.

The presenters will discuss the concept of “diagnostic consultation-liaison (CL) psychiatry” a psychosomatic method to understand treatment-resistant depression's subsets based on comorbid medical illness. The presenters will describe, using clinical examples, the application of diagnostic psychiatry in psychosomatic medicine, and discuss a stepwise approach to TRD based on comorbid medical illness, including promising new neuromodulation approaches. By the end of the symposium, participants will have been exposed to the many facets of TRD’s subsets, the differences in the management, and the best time to intervene psychiatrically.

Dr. Muhammad: 15 min: Will identify the concept of " Diagnostic CL Psychiatry", then discuss the initiative to classify TRD based on the contributing comorbid medical illness in CL psychiatry. For example, TRD in cancer survivors, TRD in autoimmune disorders, and TRD in transplant patients.

Dr. Federoff: 15 min: Will present a case example to clarify the unique facets of TRD in a transplant patient with a focus on the multiple dimensions that affect the choice and the course of treatment. Challenges in the management of such cases will be discussed.

Dr. Ye: 15 min: Will present a case with the focus on exploring the subjective experiences of TRD in cancer survivors’ patients. She will then discuss the impact of chronic suicidality on the management of the geriatric population.

Dr. Bass: 15 min: Will discuss the major consequences of psychiatric interventions: Electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) in some specific cases. He will go through the benefits and risks of each intervention.

Dr. Daskalakis: 15 min: Will wrap up with the UCSD experience in developing neuromodulation and also the clinical trial implications of treating patients with comorbid depression and medical disorders.

The session is intended to be an interactive symposium and at least 15 minutes will be reserved for questions and a discussion of the current TRD management's approaches of attendees and potential ideas each can implement in their own practices.


REF:
-Magnetic Seizure Therapy for Suicidality in Treatment-Resistant Depression: Daskalakis et al: JAMA, 2020 Aug