{"page":"\u003clink rel=\"stylesheet\" href=\"https://lessonplanet.com/assets/packs/css/resources-c03aa079.css\" /\u003e\n\u003clink rel=\"stylesheet\" href=\"https://lessonplanet.com/assets/packs/css/lp_boclips_stylesheets-517835be.css\" media=\"all\" /\u003e\n\u003cdiv data-title='What is Treatment Resistant Depression? What Do We Do about it?' data-url='/boclips/videos/65112e8260795c4682b86579' data-video-url='/boclips/videos/65112e8260795c4682b86579' id='bo_player_modal'\u003e\n\u003cdiv class='boclips-resource-page modal-dialog panel-container'\u003e\n\u003cdiv class='react-notifications-root'\u003e\u003c/div\u003e\n\u003cdiv class='rp-header'\u003e\n\u003cdiv class='rp-type'\u003e\n\u003ci aria-hidden='true' class='fai fa-regular fa-circle-play'\u003e\u003c/i\u003e\nVideo\n\u003c/div\u003e\n\u003ch1 class='rp-title' id='video-title'\u003e\nWhat is Treatment Resistant Depression? What Do We Do about it?\n\u003c/h1\u003e\n\u003cdiv class='rp-actions'\u003e\n\u003cdiv class='mr-1'\u003e\n\u003ca class=\"btn btn-success\" data-posthog-event=\"Signup: LP Signup Activity\" data-posthog-location=\"body_link_boclips\" data-remote=\"true\" href=\"/subscription/new\"\u003e\u003cspan\u003e\u003cspan\u003eGet Free Access\u003c/span\u003e\u003cspan class=\"\"\u003e for 10 Days\u003c/span\u003e\u003cspan\u003e!\u003c/span\u003e\u003c/span\u003e\u003c/a\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class='rp-body'\u003e\n\u003cdiv class='rp-info'\u003e\n\u003cdiv aria-label='Hide resource details' class='rp-hide-info' role='button' tabindex='0'\u003e\u0026times;\u003c/div\u003e\n\u003ci aria-label='Expand resource details' class='rp-expand-info fai fa-solid fa-up-right-and-down-left-from-center' role='button' tabindex='0'\u003e\u003c/i\u003e\n\u003ci aria-label='Compress resource details' class='rp-compress-info fai fa-solid fa-down-left-and-up-right-to-center' role='button' tabindex='0'\u003e\u003c/i\u003e\n\u003cdiv class='rp-rating'\u003e\n\u003cspan class='resource-pool'\u003e\n\u003cspan class='pool-label'\u003ePublisher:\u003c/span\u003e\n\u003cspan class='pool-name'\u003e\n\u003cspan class='text'\u003e\u003ca data-publisher-id=\"30356011\" href=\"/search?publisher_ids%5B%5D=30356011\"\u003eCurated Video\u003c/a\u003e\u003c/span\u003e\n\u003c/span\u003e\n\u003c/span\u003e\n\u003c/div\u003e\n\u003cdiv class='rp-description'\u003e\n\u003cspan class='short-description'\u003eTreatment resistant depression is defined as having 2 failed, 6-week antidepressant trials. Another way of putting is, you have depression, you take medication for at least 6 weeks and you don’t get better. Then you try another...\u003c/span\u003e\n\u003cspan class='full-description hide'\u003eTreatment resistant depression is defined as having 2 failed, 6-week antidepressant trials. Another way of putting is, you have depression, you take medication for at least 6 weeks and you don’t get better. Then you try another medication and still no luck.\u003cbr/\u003e \u003cbr/\u003e However, when you take the medication, you need to take it at a minimally therapeutic dose for 6 weeks. This is usually not the starting dose. For example, the minimally therapeutic dose of Zoloft for depression is 50mg – 100mg. The maximum dosage is 200mg. If you see a doctor and are put on 25mg and stay there for 2 months and don’t feel better, that’s not a failed trial of the medication. The first step is to increase the dose to a minimum of 50mg but likely 100mg before making a final decision. In my own practice, I wouldn’t consider 6 weeks on 50mg a failure. However, sometimes you are unable to increase the dose without getting a lot of side effects. So, you may have noticed a tiny improvement with 50mg, your doctor increases you to 100mg and you lose your sex drive, or you get insomnia.\u003cbr/\u003e \u003cbr/\u003e If this is the case, you haven’t failed Zoloft, you’re limited by side effects. Your doctor would probably still switch you to another medication because you need to be able to tolerate the medication enough to get it up to a therapeutic dose. I mention this because side effects are common and if you’ve tried 3 or 4 antidepressants and had to stop because of side effects, this doesn’t mean you’re treatment resistant.\u003cbr/\u003e \u003cbr/\u003e Medication options for treatment resistance:\u003cbr/\u003e The atypical antipsychotics: Abilify, Seroquel, Zyprexa and Rexulti.\u003cbr/\u003e Lithium\u003cbr/\u003e Thyroid hormone\u003cbr/\u003e Mirtazepine\u003cbr/\u003e Mirapex (pramipexole)\u003cbr/\u003e L-Methylfolate \u003cbr/\u003e SamE \u003cbr/\u003e \u003cbr/\u003e Non-medication options are:\u003cbr/\u003e Electroconvulsive therapy (ECT)\u003cbr/\u003e Transcranial Magnetic Stimulation (TMS)\u003cbr/\u003e \u003cbr/\u003e For more information on Depression, see the Depression \u003ca href='https://goo.gl/eFCdQo' target='_blank' rel='nofollow'\u003eplaylist\u003c/a\u003e \u003cbr/\u003e \u003cbr/\u003e References\u003cbr/\u003e The thing about 40-60% of TRD being bipolar\u003cbr/\u003e Francesca, MM et. Al. Clin Pract Epidemiol Ment Health, 2014; 10:42-47\u003cbr/\u003e \u003cbr/\u003e Lithium reducing suicide risk\u003cbr/\u003e Tondo L et al, Curr Psychiatry Rep 2016;18:88\u003cbr/\u003e \u003cbr/\u003e Cohen BM, Sommer BR, Vuckovic A. Antidepressant-Resistant Depression in Patients With Comorbid Subclinical Hypothyroidism or High-Normal TSH Levels. Am J Psychiatry. 2018;175:598-604\u003cbr/\u003e \u003cbr/\u003e Disclaimer: All of the information on this channel is for educational purposes and not intended to be specific/personal medical advice from me to you. Watching the videos or getting answers to comments/question, does not establish a doctor-patient relationship. If you have your own doctor, perhaps these videos can help prepare you for your discussion with your doctor.\u003cbr/\u003e \u003cbr/\u003e\u003c/span\u003e\n\u003c/div\u003e\n\u003cdiv class='action-container flex justify-between'\u003e\n\u003cbutton aria-expanded='false' aria-label='Read more description' class='rp-full-description' type='button'\u003e\n\u003ci class='fai fa-solid fa-align-left'\u003e\u003c/i\u003e\n\u003cspan id='read_more'\u003eRead More\u003c/span\u003e\n\u003c/button\u003e\n\u003cdiv class='rp-report'\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv aria-labelledby='resource-details-heading' class='rp-info-section'\u003e\n\u003ch2 class='title' id='resource-details-heading'\u003eResource Details\u003c/h2\u003e\n\u003cdiv class='rp-resource-details clearfix'\u003e\n\u003cdiv class='detail'\u003e\n\u003cdl\u003e\n\u003cdt\u003eCurator Rating\u003c/dt\u003e\n\u003cdd\u003e\u003cspan class=\"star-rating\" aria-label=\"4.0 out of 5 stars\" role=\"img\"\u003e\u003ci class=\"fa-solid fa-star text-action\" aria-hidden=\"true\"\u003e\u003c/i\u003e\u003ci class=\"fa-solid fa-star text-action\" aria-hidden=\"true\"\u003e\u003c/i\u003e\u003ci class=\"fa-solid fa-star text-action\" aria-hidden=\"true\"\u003e\u003c/i\u003e\u003ci class=\"fa-solid fa-star text-action\" aria-hidden=\"true\"\u003e\u003c/i\u003e\u003ci class=\"fa-regular fa-star text-action\" aria-hidden=\"true\"\u003e\u003c/i\u003e\u003c/span\u003e\u003c/dd\u003e\n\u003c/dl\u003e\n\u003c/div\u003e\n\u003cdiv class='detail'\u003e\n\u003cdl\u003e\n\u003cdt class=\"educator-rating-title\"\u003eEducator Rating\u003c/dt\u003e\u003cdd\u003e\u003cdiv class=\"educator-rating-details\" data-path=\"/educator_ratings/rrp_data?resourceable_id=82566646\u0026amp;resourceable_type=Boclips%3A%3AVideoMetadata\"\u003e\u003cspan class=\"not-yet-rated\"\u003eNot yet Rated\u003c/span\u003e\u003c/div\u003e\u003c/dd\u003e\n\u003c/dl\u003e\n\u003c/div\u003e\n\u003cdiv class='detail'\u003e\n\u003cdl\u003e\n\u003cdt\u003eMedia Length\u003c/dt\u003e\n\u003cdd\u003e11:23\u003c/dd\u003e\n\u003c/dl\u003e\n\u003c/div\u003e\n\u003cdiv class='detail'\u003e\n\u003cdl\u003e\n\u003cdt\u003eGrade\u003c/dt\u003e\u003cdd title=\"Grade\"\u003eHigher Ed\u003c/dd\u003e\n\u003c/dl\u003e\n\u003c/div\u003e\n\u003cdiv class='detail'\u003e\n\u003cdl\u003e\n\u003cdt\u003eSubjects\u003c/dt\u003e\u003cdd\u003e\u003cspan\u003e\u003ca href=\"/search?grade_ids%5B%5D=259\u0026amp;search_tab_id=1\u0026amp;subject_ids%5B%5D=1319782\"\u003eCareer \u0026amp; Technical Education\u003c/a\u003e\u003c/span\u003e\u003c/dd\u003e\u003cdd class=\"text-muted\"\u003e\u003ci class=\"fa-solid fa-lock mr5\"\u003e\u003c/i\u003e1 more...\u003c/dd\u003e\n\u003c/dl\u003e\n\u003c/div\u003e\n\u003cdiv class='detail'\u003e\n\u003cdl\u003e\n\u003cdt\u003eMedia Type\u003c/dt\u003e\u003cdd\u003e\u003cspan\u003e\u003ca href=\"/search?grade_ids%5B%5D=259\u0026amp;search_tab_id=2\u0026amp;type_ids%5B%5D=4543647\"\u003eInstructional Videos\u003c/a\u003e\u003c/span\u003e\u003c/dd\u003e\n\u003c/dl\u003e\n\u003c/div\u003e\n\u003cdiv class='detail'\u003e\n\u003cdl\u003e\n\u003cdt\u003eSource:\u003c/dt\u003e\n\u003cdiv class='preview-source' data-animation='true' data-boundary='.rp-info' data-container='.rp-resource-details' data-html='false' data-title='I am a psychiatrist in Atlanta with over 20 years experience. This channel teaches you about mental health issues and self-improvement. Why? Because education empowers. You will learn about bipolar disorder, depression, anxiety, attention deficit disorder, schizophrenia and more. I group the videos for these topics into playlists. Youtube allows you to save playlists to your library. If you are interested in only one topic, you can save the playlist and see when new videos on that topic are published.' data-trigger='hover focus'\u003e\n\u003cspan\u003eDr. Tracey Marks\u003c/span\u003e\n\u003ci aria-hidden='true' class='fa-solid fa-circle-info channel-tooltip-icon' id='channel-tooltip'\u003e\u003c/i\u003e\n\u003c/div\u003e\n\u003c/dl\u003e\n\u003c/div\u003e\n\u003cdiv class='detail'\u003e\n\u003cdl\u003e\n\u003cdt\u003eDate\u003c/dt\u003e\n\u003cdd\u003e2018\u003c/dd\u003e\n\u003c/dl\u003e\n\u003c/div\u003e\n\u003cdiv class='detail'\u003e\n\u003cdl\u003e\n\u003ci aria-hidden='true' class='fai fa-solid fa-language'\u003e\u003c/i\u003e\n\u003cdt\u003eLanguage\u003c/dt\u003e\u003cdd\u003eEnglish\u003c/dd\u003e\n\u003c/dl\u003e\n\u003c/div\u003e\n\u003cdiv class='detail'\u003e\n\u003cdl\u003e\n\u003cdt\u003eAudiences\u003c/dt\u003e\u003cdd\u003e\u003cspan\u003e\u003ca href=\"/search?audience_ids%5B%5D=371079\u0026amp;grade_ids%5B%5D=259\u0026amp;search_tab_id=1\"\u003eFor Teacher Use\u003c/a\u003e\u003c/span\u003e\u003c/dd\u003e\u003cdd class=\"text-muted\"\u003e\u003ci class=\"fa-solid fa-lock mr5\"\u003e\u003c/i\u003e2 more...\u003c/dd\u003e\n\u003c/dl\u003e\n\u003c/div\u003e\n\u003cdiv class='detail'\u003e\n\u003cdl\u003e\n\u003cdt\u003eUsage Permissions\u003c/dt\u003e\u003cdd\u003eFine Print: Educational Use\u003c/dd\u003e\n\u003c/dl\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv aria-labelledby='additional-materials-heading' class='rp-info-section'\u003e\n\u003ch2 class='title' id='additional-materials-heading'\u003eAdditional Materials\u003c/h2\u003e\n\u003cdiv class='additional-material'\u003e\n\u003ci aria-hidden='true' class='fai fa-solid fa-lock'\u003e\u003c/i\u003e\n\u003ca class=\"text-muted\" title=\"Video Transcript\" data-html=\"true\" data-placement=\"bottom\" data-trigger=\"click\" data-content=\"\u003cdiv class=\u0026quot;text-center py-2\u0026quot;\u003e\u003ca class=\u0026quot;bold\u0026quot; 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