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General psychiatry
TRD treatment options

You have managed to get help for depression, but you still do not feel yourself despite taking your medication and doing everything you can.

If you have tried two or more different antidepressants and you have not recovered, you should consider an evaluation to discuss further treatment options.

The literature says the following:

  • About 33% of patients with depression are still depressed after trying two different types of antidepressants.
  • Among patients with unipolar major depression who receive initial treatment, the estimated incidence of treatment resistance ranges from approximately 45 to 65 percent.
  • Risk factors include general medical and psychiatric comorbidity, severe degree of depressive symptoms, and adverse life events.


This means that for every patient treated for depression, two will not recover.
If you relate to this, you should know that there is hope!

Suffering from depression costs a lot. To suffer from depression that does not improve after trying two different antidepressants cost even more- nobody can afford to remain depressed.

Depression comes in different degrees. For those patients who suffer from a severe degree of depression, treatment by a specialist psychiatrist is necessary.

After a careful evaluation, your psychiatrist will discuss treatment options such as admission, psychotherapy or a combination of medication.

Treatment options for TRD
Transcranial Magnetic Stimulation (TMS)

TMS is a relative new treatment is South Africa. It is an effective treatment for TRD with relative mild side-effects.

TMS has the following benefits:

  • The patient is awake during the process and can drive home afterward
  • There is no need for a theatre or anesthetist
  • The patients do not report memory loss
  • The series of treatments can be squeezed into one week
  • The treatment is individualized to treat other conditions than depression
Electroconvulsive Treatment (ECT)

ECT remains the gold standard treatment for severe depression, and it can be life-saving in the following scenarios:

  • Catatonic depression
  • Depression in pregnancy
  • Depression or mania with psychosis

We are offering all the most effective treatments for TRD in Benoni. We believe in ethical, evidence-based practice guidelines and consult with all our patients to co-plan each patient’s treatment.
We actively engage with medical aids to ensure funding for evidence-based treatments.

Inpatient treatment

Unipolar major depression (major depressive disorder) is diagnosed in patients who have suffered at least one major depressive episode and have no history of mania or hypomania

Inpatient treatment

Treatment-resistant depression typically refers to a major depressive episode that does not respond satisfactorily after two trials of antidepressant monotherapy; however, the definition has not been standardized.

Multi-disciplinary teams

– Treatment-refractory depression typically refers to unipolar major depressive episodes that do not respond satisfactorily to many sequential standard regimens, including multiple antidepressants and adjunctive drugs, as well as at least one trial each of adjunctive psychotherapy, repetitive transcranial magnetic stimulation, and electroconvulsive therapy. However, the definition has not been standardized, and no clear demarcation exists between treatment-resistant and treatment-refractory depression.

  • Suicidal or homicidal ideation or behaviour, or ideation that pose an imminent risk. Ideation that pose an imminent risk includes the wish or hope that death will overtake oneself (e.g., “Life is not worth living” or “I would be better off dead”); or fleeting thoughts of killing oneself, with plans to commit suicide and intent.
  • Psychotic features (e.g., delusions or hallucinations).
  • Moderate to severe aggressiveness.
  • Impaired judgment such that the patient or others are at eminent risk of being harmed
  • Impaired functioning is obvious.
  • In addition, severe major depression is indicated by a score of >20 points on the Patient Health Questionnaire – Nine Item (PHQ-9).
  • Comorbid general medical disorders (e.g., coronary heart disease and hypothyroidism
  • Chronic pain
  • Medications (e.g., glucocorticoids and interferons)
  • Comorbid psychiatric disorders (e.g., anxiety, personality, and substance use disorders)
  • Severe intensity of depressive symptoms
  • Suicidal thoughts and behaviour
  • Adverse life events (e.g., childhood trauma or marital discord)
  • Personality traits (e.g., low reward-dependence, low extraversion, and high neuroticism)
  • Early age of onset of major depression (e.g., age <18 years)
  • Recurrent depressive episodes
  • Loss of employment and low socioeconomic statu
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