Denee T, Kerr C, Ming T, et al. - Researchers aimed at delineating current clinical management of patients with major depressive disorder (MDD) and treatment-resistant depression (TRD) in England, including treatment strategies and referral to secondary mental healthcare. Using the Clinical Practice Research Datalink GOLD primary care database linked to Hospital Episode Statistics and Mental Health Services Data Set data (Protocol 19_019R), they identified 41,375 patients with MDD (mean age 44yrs, 62% female, median follow-up 29mths) and 1,051 (3%) patients with TRD. Mean time-to-TRD was 18 months. Mostly, the patients received first-line antidepressant monotherapy (> 99%). Overall many patients frequently cycle through numerous antidepressants with similar mechanisms of action and efficacy despite current clinical guidelines recommending a stepwise approach. Findings thereby suggest a high unmet necessity for novel therapies that improve outcomes in these patient populations.