NEI Podcast E270 - (CME) Complex Depression: Treating Beyond the Standard Algorithm
Dec 3, 2025
Stephen Stahl, a renowned psychiatrist and psychopharmacology expert, joins Roger McIntyre, a clinical researcher in mood disorders, to tackle the complexities of depression. They explore how to recognize and manage major depressive episodes with mixed features and the implications of DSM-5 specifiers on treatment. Highlights include discussions on the urgent need for updated guidelines, the efficacy of atypical antipsychotics, and the importance of individualized care to bridge the gap between evidence and practice in mental health treatment.
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Ketamine Remission In A Refractory Case
- A truck driver with refractory depression remitted after low‑dose IV ketamine after failing meds, TMS, and ECT.
- Roger McIntyre used this to illustrate pseudo‑TRD when a correct treatment hits the right mechanism.
DSM‑5 Specifiers Identify High‑Risk Subgroups
- DSM-5 specifiers 'anxious distress' and 'mixed features' help identify subgroups with worse outcomes.
- These specifiers predict greater severity, chronicity, suicidality, and poorer SSRI response.
Augment Early For Anxious/Mixed Features
- Consider atypical antipsychotic augmentation when anxious or mixed specifiers predict SSRI nonresponse.
- Stephen M. Stahl notes SSRIs work roughly half as well with anxious distress and can worsen mixed features.