Why Pharmacotherapy Alone May 'Fail' in Complex TRD (Treatment-Resistant Depression)
Thinking In PsychiatryShow Notes
To access the full episode and over 150+ hours of cutting-edge, interactive courses on Psychiatry subscribe to The Academy: https://psychscene.co/4qfNAny In this episode, Consultant Psychiatrist, Dr Sanil Rege looks at treatment refractory mood disorders through a psychodynamic lens using a naturalistic study from the Austen Riggs Centre.
A subset of what most see as Treatment-Resistant Depression (TRD) isn't just pharmacological non-response; it's depression embedded within personality organisation, trauma-related aspects, attachment, and unconscious patterns.
This podcast provides clinicians with a psychodynamic perspective to understand how clinical refractoriness to standard pharmacotherapy can be sustained by meaning, defences, and relational patterns, not just neurotransmitters.
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Access mentioned course here: Advanced Psychiatric Formulation and Strategic Management Masterclass https://psychscene.co/3Rn0Sm3 Here is the link to the paper mentioned: Towards a Consensus Roadmap for a New Diagnostic Framework for Mental Disorders https://www.sciencedirect.com/science/article/pii/S0924977X24007168 In this episode, Dr Sanil Rege examines a 2025 ECNP consensus roadmap calling for psychiatry to move beyond descriptive diagnosis towards biology-informed, transdiagnostic, and mechanism-based models. He explores how circuit biomarkers, inflammation, genomic overlap, digital phenotyping, and machine learning may refine patient stratification, treatment selection, and relapse prediction across traditional diagnostic boundaries. This video provides clinicians with a neurobiological framework for shifting from label-based treatment to mechanism-informed formulation in psychiatric practice.
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