Unmet Needs in MDD Treatment With Dr Charles DeBattista

Dr Charles DeBattista, professor of psychiatry at Stanford University, discusses the ongoing unmet needs in the treatment of major depressive disorder (MDD) while on-site at Psych Congress 2023 in Nashville, Tennessee. Here, he highlights key insights from his Psych Congress session that explored the hurdles patients with MDD face, from treatment tolerability issues to limited access to innovative therapies. Dr DeBattista also sheds light on signs of treatment-resistant depression (TRD) and the tools available to practicing psychiatrists for more consistent and effective screening.

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Read the transcript:

Hello, I'm Dr Charles DeBattista, a professor of psychiatry and behavioral Sciences at Stanford University. I'm also the director of the Depression Research Clinic and Director of Medical Student Education in Psychiatry at Stanford.

Question: What are some of the unmet needs that persist for patients with major depressive disorder?

Dr Charles DeBattista: Despite the fact that we have lots of treatments that help patients, there's still an important subset of patients that don't respond to or necessarily tolerate the treatments that we do have. Many patients have significant side effects with the available treatments, and many others don't respond, even though we've tried multiple medications and various devices and so forth. In addition, access is still a problem for some patients. New branded medications tend to be expensive. Many insurance companies don't allow those kinds of branded medications.

In addition, technologies like transcranial magnetic stimulation, so forth, are sometimes not available to many patients, particularly in rural communities. Medications, especially oral medications, take a long time to work if they're going to work. If they don't work, it means trying an additional medication, which also takes time, and maybe trying multiple medications in a series. We don't have great biomarkers as of yet that help us predict response to treatment. These are all things, though, that progress is being made on as we speak.

Q: What are some signs of treatment-resistant depression that clinicians should be on the lookout for? Which tools are available to make screening more consistent and effective?

Dr DeBattista: There isn't a consensus definition about treatment resistance. Investigators have used different criteria for treatment resistance. One common criteria is the failure of 2 or more adequate medication trials. That means adequate dose and adequate duration. Now, the way we monitor patients typically is with a number of standard depression scales. These can include things like the Montgomery-Asberg Depression Scale or the Hamilton Depression Scale. None of them are perfect, but at the same time, they do quantify the level of response or lack of response, and so it's what we tend to use in the clinic as well as our investigations.

Charles DeBattista, DMH, MD, is currently professor of psychiatry and Behavioral Sciences at Stanford University School of Medicine. In addition to serving as director of medical student education in psychiatry at Stanford, he also is the director the Depression Research Clinic and Co-Section Chief of the Mood Disorder Clinics.