Prof. Eric Ruhé

In my presentation I will address several aspects why the understanding of major Depressive Disorder (MDD) has only slightly been improved in the last decades and why treatments do not develop rapidly, ultimately making depression often Treatment Resistant, which is better addressed by ‘Difficult to Treat Depression’.

First, I will address upcoming solutions for the understanding and tackling of heterogeneity in MDD. Second, I will address the clinical dilemma of many treatment possibilities, combinations: this is a big arsenal of treatments, but also a kind of misty environment to choose in. For this, I will suggest how to proceed, based on the existing evidence from clinical trials by properly using Network Meta Analyses, real world evidence, expert opinions and clinical guidelines. Third, I will elaborate on the caveat between understanding that treatments are efficacious versus understanding their mechanisms of change leading to improvement of symptoms/dimensions or functioning. Finally, I will address how we -in my group- aim to address this caveat by the use of innovative analyses based on (multi-modal) neuro-imaging. With dynamic whole-brain computational models, we aim to improve understanding of both DTD and the treatments with different pharmacological or neuromodulatory targets.

With my talk I want to summarize where we stand in the field of DTD and how to improve our approach to understand and target DTD, in order to better help our patients.