UCH Psychiatry Outpatient Service
Treatment Resistant Depression Specialty Clinic
The Treatment Resistant Depression specialty Clinic is a gateway to complete assessment, systematic treatment and experimental approaches to the treatment of Depression. This specialty clinic accepts patients referred by their psychiatrists or primary care physicians in the community. It is also opened to all adults who are patients of the UCH outpatient clinic.
Depression is a problem marked by periods of feeling so sad, blue or lonely that it affects the person’s ability to relate to family and friends or work efficiently. The depression also affects things like sleep, appetite, concentration, and self-confidence.
Treatment resistant depression is a frustrating and potentially disabling condition. Those with treatment resistant depression may be referred to the clinic after failing to respond to routine medicine or psychotherapy treatments provided by their primary care physician and/or psychiatrist. The clinic provides a thorough assessment and complex treatments for this severe type of depression, offering additional options and hope to those suffering from this illness.
For Patients
The Treatment Resistant Depression clinic is open to all adult patients of the UCH outpatient clinic. The clinic also accepts patients referred by their psychiatrists in the community.
Hours of Operation
Tuesdays 9:00 a.m. to 12:00 noon
To Make an Appointment:
303-724-1005
What to Expect
First Appointment:As a patient at the Treatment Resistant Depression Clinic, your first appointment will be scheduled for two hours. You will be interviewed about your past to see if your history is consistent with treatment resistant unipolar depression. A clear history of each episode of depression will help you and your physician better understand the course of your illness over time and how the depression has affected your life. Your psychiatrist may order blood work and/or other diagnostic tests to assure that no medical problems are causing the depression or contributing to treatment resistance. In addition, the possibility of other co-existing psychiatric problems will be explored thoroughly to assure that substance use, prescription drugs, or other mood or anxiety disorders are not present. Your psychiatrist will review with you all treatments you may have received (medication, psychotherapy, phototherapy, electro-convulsive therapy, vagus nerve stimulation) to determine how treatment resistant your depression has been. Your lifestyle, ongoing life stressors and coping skills will be assessed to determine whether they have contributed to the treatment resistance.
Treatment:Under the supervision of a University of Colorado faculty psychiatrist, a psychiatry resident (your treating physician) will complete the initial evaluation. The physician will work with you to create a specialized treatment plan based on how severe your current problem is and how much the depression affects your social or work life. In addition, your treatment plan will consider other medical problems that may be affecting your health or well-being. This plan may include other tests, gathering additional information, prescription medication, and/or psychotherapy. The type of psychotherapy recommended would be based both on research demonstrating treatment effectiveness and your learning style. Your psychiatrist may recommend a combination of psychotherapy and medication. You and your physician may also discuss alternative treatments such as electro-convulsive therapy, vagus nerve stimulation or involvement in research studies. Your physician will track your progress using research-based rating scales and will make changes in the treatment plan as needed.
You will also be given education and support to help make changes in your lifestyle that may reduce depressive symptoms.
The clinic offers group therapies including stress management, cognitive behavioral therapy and interpersonal therapy. In addition, Recovery Inc., a community-based organization, offers a free weekly support group during clinic hours.
Physicians and Staff
The Treatment Resistant Depression service is directed by Dr. Neil Weiner. Dr. Weiner is an assistant professor in the Department of Psychiatry. Dr. Weiner has been recognized for his work in clinical practice in the Denver community (since 1987) through recognition in 5280 magazine as one of Denver’s top physicians in 2003, 2004, and 2005. Dr. Weiner is currently working on two research projects in the Department, one related to bipolar depression and the other related to outcomes of teaching evidence-based medicine to psychiatry residents.
How to Get a Referral
Your primary care physician or psychiatrist can refer you to the Treatment Resistant Depression Clinic by contacting Tanjala Wilson at 303-724-1005 to alert her to the referral. Then you should contact Ms. Wilson directly to schedule an evaluation and mention the name of your referring physician.
You may also contact Ms. Wilson to request an evaluation in the Treatment Resistant Depression Clinic without a physician's referral.
For Medical Professionals
The Treatment Resistant Depression service utilizes evidence-based biological and psychotherapeutic treatments including individual and group therapy.
Patient Assessment
The initial evaluation is scheduled for two hours. Patients are thoroughly assessed for the following disorders:
- Major Depression
- Dysthymia
- Major Depression with psychotic features
- Bipolar Depression
- Seasonal Affective Disorder
- Schizoaffective Disorder
The patient is also assessed for other Axis I diagnoses, with special attention to the most common co-morbid conditions seen with treatment resistant depression including anxiety disorders, attention deficit disorder, substance abuse or dependence and eating disorders. Bipolar depression is carefully considered and collaborative history, if needed, is obtained to rule out this possibility. Medical illnesses that may present with depressive symptoms are considered and chronic illnesses that may contribute to ongoing depressive symptoms are carefully reviewed. A thorough lifestyle and personality assessment is completed to determine how these factors may contribute to the patient’s depressive symptoms.
After precise clinical diagnoses have been made, specific rating scales are used to assess the severity of the depressive symptoms and to monitor treatment progress over time.
Treatment
Treatment plans are staged based on the severity of the depression and co-morbidity profiles. Psychiatry residents provide evidence-based psycho-pharmacologic treatments based on treatment resistant depression algorithms supported by research. Past medication trials are carefully reviewed to assure the adequacy of trials of different classes of anti-depressants, combination strategies, and augmentation strategies as well as whether or not ECT has been tried. Based on the evaluation, additional medication trials, phototherapy, ECT, vagus nerve stimulation, psychotherapy or a combination of treatments may be recommended. The patient’s learning style and motivation for specific evidence-based individual and group psychotherapies effective for his/her depressive disorder are also considered and these treatments are prescribed as appropriate. The patient’s improvement over time is monitored using standardized measures.
Patients are also provided with psycho-education and support for lifestyle modifications to reduce depressive symptoms. In addition to psychiatry residents, psychology and social work interns are also involved in providing evidence-based psychotherapies including cognitive behavioral therapy and interpersonal therapy for depression as well as stress management groups.
Physician Consultations
The clinic provides consultations to psychiatrists in the community. These consultations take place over two to three sessions and result in a consultative report and recommendations to the referring clinician. Physicians and patients may request consultations by contacting Tanjala Wilson at 303-724-1005.
Community Involvement
The depression program will maintain a leadership role in providing educational opportunities and consultative resources to community-based physicians. In addition, the program will continue to participate in research that is focused on improving outcomes in treatment resistant depression.
Education
The director of the clinic will define a specific curriculum and learning opportunities for psychiatry residents and psychology and social work interns that include classroom didactic sessions, computer guided literature review supporting evidence-based treatments, individual and group supervision, research opportunities, and electives.
Psychiatry residents will be skilled in the thorough assessment and treatment of complex depressive disorders. Residents will be familiar with evidence-based psychotherapies studied for depression as well as new biological treatments such as vagus nerve stimulation and techniques that are being researched such as trans-cranial magnetic stimulation and deep brain stimulation.
Faculty
Dr. Neil Weiner, an assistant professor in the Department of Psychiatry, will provide oversight and clinical direction to the specialty clinic. Dr. Weiner will supervise psychiatry residents in consultations, evaluations, psycho-pharmacologic and psychotherapeutic treatments specific to treatment resistant depression.
