Nonpharmacologic treatments for treatment-resistant depression

Failure to respond to initial treatment plans involving psychotherapy and/or an antidepressant medication is common. Treatment-resistant depression or TRD, is a term used to describe MDD that does not respond to initial treatment with antidepressant medication, which is considered appropriate for moderate to severe MDD. Nonpharmacologic treatments are often tried when pharmacotherapy has failed or has proved intolerable to a patient. Such options include electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), deep brain stimulation (DBS), transcranial direct current stimulation (tDCS), and vagus nerve stimulation (VNS).

Status: Decision completed

Why is nonpharmacologic treatments for TRD being reviewed?

Nonpharmacologic treatments for depression that does not respond to first line treatments was selected for review based on concerns about the safety, efficacy and cost of the treatments. Depression is relatively common among adults and contributes to or is associated with higher rates of other disease processes, disability and reduced quality of life. This review will help to identify safe and effective evidenced-based care for TRD.

Primary criteria ranking

  • Safety = Medium
  • Efficacy = High
  • Cost = Medium

Documentation

Assessment timeline

  • Draft key questions published: September 19, 2013 
  • Public comment period: September 19 to October 3, 2013 
  • Draft report published: December 19, 2013 
  • Public comment period: December 19 to January 17, 2014 
  • Final report published: February 24, 2014 
  • HTCC public meeting: March 21, 2014