💊 Treatment-Resistant Depression Algorithm Simulator

The First Antidepressant Trial — Adequate Dose, Adequate Duration, Inadequate Result

Placeholder lead: defines an adequate trial and why many first attempts fall short.

• 6–8 wks: Adequate trial length (placeholder caption)
• ~50–60%: First-line response rate (placeholder caption)
• ~37%: Remission rate (STAR*D step 1) (placeholder caption)
• SSRI: Common first-line class (placeholder caption)

What counts as an adequate trial

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Why response is judged at 6–8 weeks

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Second Trial, Different Class — Two Failures Define Treatment Resistance

Placeholder lead: switching class and confirming TRD after two failed trials.

• 2+ trials: TRD definition threshold (placeholder caption)
• ~31%: STAR*D step 2 remission (placeholder caption)
• ~50%: Cumulative remission after 2 steps (placeholder caption)
• Cross-class: Typical switch strategy (placeholder caption)

Defining treatment-resistant depression

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Switch vs. augment decision point

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Adding Lithium — Enhancing Serotonergic Antidepressant Effect

Placeholder lead: lithium augmentation mechanism and evidence base.

• ~40–50%: Response rate added (placeholder caption)
• 0.6–0.8 mEq/L: Typical serum target (placeholder caption)
• 2–4 wks: Onset of benefit (placeholder caption)
• Levels, TSH, Cr: Monitoring needed (placeholder caption)

Proposed serotonergic mechanism

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Dosing and monitoring considerations

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Low-Dose Atypical Antipsychotic Augmentation, or Combining Two Antidepressants

Placeholder lead: aripiprazole-type augmentation vs. complementary dual-antidepressant strategy.

• ~45–55%: Aripiprazole response add (placeholder caption)
• 2–10 mg: Typical low dose range (placeholder caption)
• SSRI + bupropion: Combination example (placeholder caption)
• Several: FDA-approved adjuncts (placeholder caption)

Atypical antipsychotic augmentation

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Combining complementary antidepressants

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Response Rates Across the Ladder — and What Comes Next

Placeholder lead: cumulative response and the handoff to ECT, ketamine, or TMS.

• ~65%: Cumulative response (placeholder caption)
• ECT/ketamine/TMS: If augmentation fails (placeholder caption)
• 4: Steps modeled here (placeholder caption)
• Outside this page: Next-tier scope (placeholder caption)

Cumulative response across steps 1–4

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When to escalate beyond augmentation

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