When First-Line Fails: Practical Approaches to Treatment-Resistant Depression

madman

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Are you a healthcare professional looking to deepen your understanding of the latest depression treatment strategies? Join us on The Curbsiders as Dr. Matthew Frankwato and Dr. Paul Nelson Williams welcome back renowned guest Dr. Jesse Gold to discuss advanced topics in managing treatment-resistant depression. This episode provides an essential guide for primary care providers, covering critical screening methods, first-line medications, and innovative alternative therapies to enhance patient care.

In this deep-dive episode, our experts review foundational considerations like ruling out comorbid medical conditions and the importance of pushing medication dosages to an effective level. They also explore the nuances of tapering medications with difficult side effects, such as those from SNRIs like venlafaxine. We also highlight the potential of adjunctive treatments and emerging therapies like transcranial magnetic stimulation (TMS) and ketamine, offering a comprehensive look beyond traditional approaches.
 
 




















 

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TRT Hormone Predictor

Predict estradiol, DHT, and free testosterone levels based on total testosterone

⚠️ Medical Disclaimer

This tool provides predictions based on statistical models and should NOT replace professional medical advice. Always consult with your healthcare provider before making any changes to your TRT protocol.

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Normal range: 300-1000 ng/dL

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Understanding Your Hormones

Estradiol (E2)

A form of estrogen produced from testosterone. Important for bone health, mood, and libido. Too high can cause side effects; too low can affect well-being.

DHT

Dihydrotestosterone is a potent androgen derived from testosterone. Affects hair growth, prostate health, and masculinization effects.

Free Testosterone

The biologically active form of testosterone not bound to proteins. Directly available for cellular uptake and biological effects.

Scientific Reference

Lakshman KM, Kaplan B, Travison TG, Basaria S, Knapp PE, Singh AB, LaValley MP, Mazer NA, Bhasin S. The effects of injected testosterone dose and age on the conversion of testosterone to estradiol and dihydrotestosterone in young and older men. J Clin Endocrinol Metab. 2010 Aug;95(8):3955-64.

DOI: 10.1210/jc.2010-0102 | PMID: 20534765 | PMCID: PMC2913038

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