The Curbsiders Internal Medicine Podcast #479 Managing Treatment-Resistant Depression featuring Dr. Jessi Gold
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Apr 14, 2025 
Dr. Jessi Gold, a psychiatrist and mental health advocate, dives into managing treatment-resistant depression with expert insights. She explains the complexities of depression, including conditions that mimic it and the importance of patient context. The discussion covers innovative treatment options like transcranial magnetic stimulation and ketamine, alongside vital strategies for patient-provider communication. Dr. Gold emphasizes tailored approaches, family involvement, and the significance of patient autonomy in mental health care.
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Initial Treatment for Depression
- Start with an SSRI as the most common first-line medication for depression.
- If a patient refuses medication, discuss their concerns and make a plan for therapy with close follow-up.
Screening for Bipolar Disorder
- Assess for bipolar disorder by asking about periods of high energy, risky behaviors, or family history.
- Explain the risk of SSRI-induced mania and encourage open communication about any mood changes.
Choosing an Antidepressant
- Consider sertraline for premenstrual dysphoric disorder or duloxetine for chronic pain.
- Tailor antidepressant choice to individual patient needs and side effect profiles.
