Project ECHO helps primary care providers tackle treatment-resistant depression

HERSHEY, Pa. — Primary care providers prescribe 79% of all antidepressant medications in the United States, according to the New England Journal of Medicine, effectively serving as the frontline to the nation’s mental health system. As clinics face a growing number of patients whose depression resists standard treatments, medical leaders are increasingly turning to a data-driven approach known as measurement-based care (MBC) to improve outcomes. To equip doctors and clinical staff with these advanced strategies, Project ECHO (Extension for Community Healthcare Outcomes) at Penn State College of Medicine and the National Network of Depression Centers (NNDC) are launching a no-cost, virtual MBC training series. The program runs monthly on Tuesdays from 8 to 9 a.m. ET, starting Oct. 20, and registration is required.

In the span of a standard 15-minute primary care visit, managing treatment-resistant depression can feel overwhelming. A patient comes in with symptoms; a first-line antidepressant is prescribed, and weeks later, they return with little to no improvement. The dose is adjusted, or a second medication is tried. Despite the provider's best efforts, the patient just isn't getting better.

"Primary care providers face the challenge of seeing many patients quickly, often with limited access to mental health experts," said Mark Williams, professor of psychiatry at the Mayo Clinic and a faculty lead for the new Project ECHO at Penn State initiative. "In a short visit, prescribing medication is the most efficient option and helps many people. But, like any chronic health issue, there will always be patients who simply don't respond to routine treatments."

MBC involves using simple, standardized questionnaires at regular visits to track how a patient is feeling over time. This data-driven approach helps doctors spot early on when a patient isn't getting better, figure out their next steps, and identify other hidden health issues that might be blocking recovery.

"We would never adjust a patient's insulin based solely on how they feel that day, and depression is no different," said Errol Aksu, division director of adult outpatient psychiatry at Penn State Health and a faculty lead for the ECHO program. "Using a simple questionnaire takes just two minutes and shows a clear trend. It isn't just more paperwork; it’s the exact tool that tells a doctor if the treatment is actually working."

The series, titled "What to Do When My Depressed Patient is Not Improving: Measurement-Based Care," is open to primary care providers, nurses, physician assistants and clinical staff. Instead of just listening to a lecture, participants will use the program's "All Teach, All Learn" model to talk directly with experts and share what they are seeing in their own practices.

During the monthly sessions, attendees will have the opportunity to learn how to:

• Diagnose stubborn depression: Identify treatment-resistant depression and understand differential diagnoses.
• Manage medications: Gain practical updates on psychopharmacology and navigating bipolar disorder medications.
• Handle emergency risks: Navigate suicide risk and emergency decision-making in the clinic.
• Address hidden issues: Manage patients who have other medical and mental health conditions at the same time.
• Integrate therapies: Learn which evidence-based psychotherapies and behavioral activation techniques work in primary care.

"We want to equip providers with practical updates on medications and therapies that are proven to work," said Williams. "But the real value of the ECHO model is shared learning. By discussing the actual challenges providers face in their own clinics, we can work through these complex cases together."

"Primary care providers are delivering more mental health care than any psychiatrist in their region," Aksu added. "Our goal is not to add more to their plates, but rather to make the important work they are already doing more effective and help them feel less isolated while doing it."

Visit Project ECHO's website to learn more about the series and register for free. No-cost Continuing Medical Education (CME) credits are available.