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Nonpharmacologic Interventions for Treatment-Resistant Depression in Adults

• CME Information
• Faculty Biographies & Disclosures
• References
• Course Presentations
• CME Posttest

CME Information

Course Overview Educational Objectives Target Audience Method of Participation

Accreditation Statement Term of Approval Peer Review Program Director

Disclaimer Disclosure Acknowledgement of Support

Course Overview

Among patients who receive appropriate treatment for major depressive disorder, about 50 percent will not adequately respond. Although no universally accepted definition of treatment-resistant depression (TRD) exists, most clinicians agree that patients whose symptoms fail to respond to at least two adequate antidepressant trials are considered to have TRD.

Patients with TRD are significantly less likely to respond to subsequent medications and thus may require nonpharmacologic treatment. However, few nonpharmacologic treatments for depression are FDA approved for use in patients with TRD, and there is a paucity of evidence to inform the comparative effectiveness of the available interventions.

This CME activity covers data from a systematic review of existing research that was conducted by the RTI International–University of North Carolina Evidence-based Practice Center to evaluate the level of evidence currently available regarding nonpharmacologic interventions for the treatment of TRD. It provides an overview of the comparative benefits and harms of these interventions.

Educational Objectives

At the conclusion of this activity, the participant should be able to:

• Describe the nonpharmacologic treatment options for treatment-resistant depression, including information about availability.
• Define treatment-resistant depression, and identify which nonpharmacologic treatment options for depression are FDA-approved for use in patients with this condition.
• Communicate to patients the potential benefits of nonpharmacologic treatments for depressive symptoms that have failed to respond to two or more adequate antidepressant trials.
• Communicate to patients the potential adverse effects and contraindications associated with nonpharmacologic treatments for depression.
• Describe the strengths, limitations, and knowledge gaps in the current evidence about benefits and harms for each nonpharmacologic therapeutic intervention in the population of interest.

Target Audience

This CME activity is designed to meet the educational needs of primary care physicians and mental health professionals.

Method of Participation

This activity is in PowerPoint file format and is accompanied by talking points and references linked to PubMed abstracts.

To receive a maximum of 1.0 AMA PRA Category 1 Credit(s)™ you should:

• View the presentations in this enduring material.
• Complete the posttest (you must answer 8 out of 10 questions correctly).
• Complete and submit the CME registration and evaluation forms.

The estimated time to complete this activity, including review of the materials, is 1.0 hour(s).

Hardware/software requirements: Activities should be run with recent versions of common browsers, including Internet Explorer, Firefox, and Google Chrome.

If you have questions about the participation process, please e-mail the Office of Continuing Medical Education, cme@bcm.edu or phone 713.798.8237.

Accreditation/Credit Designation

Baylor College of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Baylor College of Medicine designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.    

Term of Approval

March 2012 through March 2015. Original release date: March 2012

Peer Review

In February 2012, this continuing medical education online enduring material was reviewed by Michael E. Thase, MD, Professor of Psychaitry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. To ensure the continued scientific relevance of this enduring material, its content will be reviewed again in March 2015.

Disclosures:  Consultant – Neuronetics, Inc. (one day)

Program Director

Michael Fordis, MD
Sr. Associate Dean
Director, Center for Collaborative and Interactive Technologies
Director,  John M. Eisenberg Center for Clinical Decisions and Communications Science
Baylor College of Medicine
Houston, Texas

Disclosures: Nothing to disclose.

Disclaimer

This CME activity is designed for use by healthcare professionals for educational purposes only. Information and opinion offered by the contributors represent their viewpoints. Conclusions drawn by the participant should be derived from careful consideration of all available scientific information. Prescription information and use of medical devices should be undertaken only after confirmation of information by consulting the FDA-approved uses and information.

Baylor College of Medicine makes every effort to have accurate information presented, no warranty, expressed or implied, is offered. The participant should use his/her clinical judgment, knowledge, experience, and diagnostic decision-making before applying any information, whether provided here or by others, for any professional use.

Links are provided to other Internet sites solely for the convenience of users. Once you link to another site, you are subject to the site's terms and conditions of use including copyright and licensing restrictions.

Disclosure

The Office of Continuing Medical Education (OCME) makes every effort to develop CME activities that are scientifically based, accurate, current, and objectively presented. In accordance with the Accreditation Council for Continuing Medical Education Standards for Commercial Support ^SM, Baylor College of Medicine (BCM) has implemented a mechanism requiring everyone in a position to control the content of an educational activity (e.g., directors, planning committee members, contributors, peer reviewers) to disclose any relevant financial relationships with commercial interests (drug/device companies) and manage/resolve any conflicts of interest prior to the activity. Individuals must disclose to participants the existence or non-existence of financial relationships: l) at the time of the activity or within 12 months prior; and 2) of their spouses/partners.

Baylor College of Medicine does not view the existence of interests or relationships with commercial entities as implying bias or decreasing the value of a presentation. It is up to the participants to determine whether the interests or relationships influence the presenter with regard to exposition or conclusions.

If at any time during this activity you feel that there has been commercial or promotional bias, please inform us by using the commercial bias comments box in the evaluation form. Please answer the questions about balance in the CME activity evaluation candidly.

The following individual(s) has/have reported financial or other relationship(s) with commercial entities whose products/services may relate to the educational content of this activity:

Michael E. Thase, MD, Peer Reviewer: Consultant – Neuronetics, Inc. (one day)

The following individual(s) has/have reported no financial or other relationships with commercial entities whose products/services may relate to the educational content of this activity:

Michael Fordis, MD, Activity Director: Nothing to disclose.
Bradley N. Gaynes, MD, MPH, Contributor: Nothing to disclose.
Mark E. Kunik, MD, MPH, Contributor: Nothing to disclose.
Linda J. Lux, Contributor: Nothing to disclose.
Emily Roberge White, Medical Writer: Nothing to disclose.

Some drugs/devices identified during this activity may have United States Food and Drug Administration (FDA) clearance for specific purposes only or for use in restricted research settings. The FDA has stated that it is the responsibility of the individual physician to determine the FDA status of each drug or device that he/she wishes to use in clinical practice and to use the products in compliance with the applicable law.

Baylor College of Medicine requires that all contributors disclose an unlabeled use or investigational use (not yet approved for any purpose) of pharmaceutical and medical device products, and provide adequate scientific and clinical justification for such use. Physicians are urged to fully review all the available data on products or procedures before using them to treat patients.

Acknowledgement of Support

This CME activity is supported by a contract, HHSA290200810015C, from the Agency for Healthcare Research and Quality.

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