Target Audience:

Physicians, pharmacists, and other health care professionals who care for people with treatment-resistant depression.

Statement of Need:

Even after years of antidepressant drug development and patient and provider education, suboptimal medication dosing and duration of exposure resulting in incomplete remission of symptoms remain the norm in treating depression. Although no particular treatment is effective for all patients, determining optimal, effective treatment approaches requires focus on the measurement of symptoms, side effects, and function.(1)

Patients often do not receive a sufficient dose of medication during routine treatment trials, suggesting that lack of remission (i.e., the absence of symptoms) may be the result of inadequate dosaging rather than ineffective treatment. Similarly, evidence shows that many patients do not receive therapeutic doses of medication for sufficient duration. Inconsistency of treatment from physician to physician is common, suggesting a practice bias rather than a tailored, individualized treatment approach. The percentage of all patients treated achieving symptom remission with initial antidepressant treatment peaks at 35%"”the remaining require at least two or more pharmacotherapeutic steps.(2)

This neuroscienceCME Snack will highlight the salient issues in treatment-resistance in MDD and delineate for clinicians the available pharmacological and nonpharmacological management options to treat to remission.

1. Trivedi MH, Daly EJ. Measurement-based care for refractory depression: a clinical decision support model for clinical research and practice. Drug Alcohol Depend. 2007;88(Suppl 2):S61-S71. PMID: 17320312.

2. Rush AJ, Kraemer HC, Sackeim HA, et al; ACNP Task Force. Report by the ACNP Task Force on response and remission in major depressive disorder. Neuropsychopharmacology. 2006;31(9):1841-1853. PMID: 16794566.


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Credit Designation:

CME Outfitters, LLC, designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Faculty Listing:

Ned H. Kalin, MD (Moderator)
Hedberg Professor and Chair
Department of Psychiatry
Director, HealthEmotions Research Institute
University of Wisconsin - Madison
Madison, WI

Charles B. Nemeroff, MD, PhD
Leonard M. Miller Professor and Chairman
Director, Center on Aging
Department of Psychiatry and Behavioral Sciences
Leonard M. Miller School of Medicine
University of Miami
Miami, FL


  • Explore all available evidence-based options when treating depression to remission.

Financial Disclosure:

Disclosure Declaration
It is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all of their CE activities. Faculty must disclose to the participants any relationships with commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CE activity. CME Outfitters, LLC, has evaluated, identified, and attempted to resolve any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process. The following information is for participant information only. It is not assumed that these relationships will have a negative impact on the presentations.

Ned H. Kalin, MD has disclosed that he received grant support from APIRE/Janssen Resident Psychiatric Mentor Grant; National Institute for Mental Health; and The Stanley Medical Research Institute. He serves as a consultant for Neuronetics and is a stockholder/maintains equity options in CeNeRx Biopharma; and Corcept Therapeutics.

Charles B. Nemeroff, MD, PhD has disclosed that he receives grants/research support from the Agency for Healthcare Research and Quality (AHRQ) and the National Institutes of Health (NIH). He serves as a consultant to Eli Lilly and Company; Shire Pharmaceuticals, Inc.; SK Pharma; Roche; Takeda Pharmaceuticals North America, Inc.; and Xhale, Inc. He serves on the scientific advisory boards of the American Foundation for Suicide Prevention (AFSP); Anxiety Disorders Association of America (ADAA); CeNeRx BioPharma; National Alliance for Research on Schizophrenia and Depression (NARSAD); PharmaNeuroBoost; Xhale, Inc.; Skyland Trail; and AstraZeneca Pharmaceuticals (2009). He serves on the board of directors of the American Foundation for Suicide Prevention (AFSP); Gratitude America; Cook Pharma, Inc. (2010); NovaDel Pharma, Inc; and Skyland Trail. He is a stockholder of CeNeRx BioPharma; NovaDel Pharma, Inc., PharmaNeuroBoost; Reevax Pharmaceuticals LLC; and Xhale, Inc. His other financial Interests include CeNeRx BioPharma and PharmaNeuroBoost. He holds patents for the following: method and devices for transdermal delivery of lithium (US 6,375,990B1); method of assessing antidepressant drug therapy via transport inhibition of monoamine neurotransmitters by ex vivo assay (US 7,148,027B2).

Tony Graham, MD (peer review) has no disclosures to report.

Robert Kennedy (planning committee) has no disclosures to report.

Joy Bartnett Leffler, MLA, NASW, CSE (planning committee) has no disclosures to report.

Sandra Haas Binford, MAEd (planning committee) has no disclosures to report.

Sharon Tordoff, CCMEP (planning committee) has no disclosures to report.

Unlabeled Use Disclosure:

Faculty of this CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices.

CME Outfitters, LLC, the faculty, and Otsuka America Pharmaceutical, Inc. do not endorse the use of any product outside of the FDA labeled indications. Medical professionals should not utilize the procedures, products, or diagnosis techniques discussed during this activity without evaluation of their patient for contraindications or dangers of use.