J&J presented data from a survey of 200 adults with depression and 151 clinicians comparing treatment preferences for treatment-resistant depression (TRD). Three things drove choices for both groups: how likely a treatment is to work after one year, whether it is FDA approved with long-term safety data, and how likely it is to work within eight weeks. Patients gave more weight than clinicians to avoiding weight gain and dissociation. The poster was presented at Psych Congress 2026.


About the study

The researchers set out to compare what people with treatment-resistant depression and the clinicians who treat them value when choosing a treatment. TRD means depression that has not improved enough after at least two antidepressants taken at the right dose for long enough.

The team ran an online survey in the United States. It included 200 adults with major depressive disorder who said they had tried at least two antidepressants for six weeks or more each. It also included 151 healthcare professionals (HCPs), mostly psychiatrists, plus psychiatric nurse practitioners and physician associates, all with at least three years of experience managing depression. Patients averaged 40 years old, and 78.5% were women.

Each person worked through 10 choice tasks. Every task showed two made-up treatments and asked which one they would pick. The treatments differed in how they are given (oral, nasal spray, IV infusion, or TMS) and in seven features:

  • FDA approval and long-term safety evidence
  • How soon it starts to work
  • Chance of response at 8 weeks
  • Chance of response at 1 year
  • Risk of dissociation
  • Risk of sexual side effects
  • Risk of weight gain

This method is called a discrete choice experiment. From the choices, the team worked out how much each feature shaped decisions.

What they found

Patients and clinicians wanted much the same things. For both groups, three features shaped choices most: the chance of response at one year, FDA approval with long-term safety data, and the chance of response at eight weeks. Avoiding IV infusion and getting a faster start mattered, but they ranked lowest.

The table shows each feature’s share of the decision. All features together add up to 100%, so a bigger number means more weight in what people chose. Each share reflects the range the survey tested for that feature, such as a chance of response at one year from 5% to 55%.

The survey also asked how much better a treatment’s results would need to be before people accepted a trade-off:

  • Evidence base. To accept a treatment without FDA approval and long-term safety data, both groups needed about a 55% improvement in the chance of an 8-week response (patients 54.6%, HCPs 56.1%), compared with a treatment that had both. Approval without long-term safety data was worth a 40.4% improvement to patients and 36.3% to HCPs.
  • How it is given. Both groups saw nasal spray and oral treatment as similar and preferred both over IV infusion. To accept IV over nasal spray, both needed about a 17% improvement in the chance of an 8-week response.

Where patients and clinicians differed

Patients gave more weight than HCPs to avoiding two side effects, and the gaps were statistically significant. Dissociation carried 12.4% of patients’ decisions versus 8.4% for HCPs. Weight gain carried 12.2% versus 7.1%.

The trade-offs show the same pattern:

  • Dissociation. For each 10% cut in dissociation risk, patients would give up a 10.7% improvement in the chance of an 8-week response. HCPs would give up 5.5%.
  • Weight gain. Removing a 30% risk of weight gain was worth a 43.1% improvement in the chance of an 8-week response to patients. To HCPs it was worth 19.2%.
  • TMS. Patients preferred nasal spray over TMS and needed a 30.0% improvement to accept TMS instead. HCPs saw the two as similar.

Patient preferences were fairly consistent across subgroups, with only small differences by time since diagnosis. HCP preferences varied by profession, gender, and practice setting, especially on 8-week response, dissociation, and sexual dysfunction. The authors describe the subgroup results as exploratory.

What this could mean for your site

This poster reports survey results, not clinical trial results. The ideas below are The STARR Coalition’s read on how sites might use it, not conclusions from the authors. The authors’ own takeaway is that treatment talks should weigh benefits and risks for each individual.

  • Be clear about what is known and what is not. Both groups needed a large boost in short-term benefit to accept a treatment without FDA approval and long-term safety data. Plain-language conversations that lay out the evidence, including the gaps, can help build trust. The authors also point to the importance of communicating the strength of the evidence base.
  • Ask participants what worries them. Patients weighed dissociation and weight gain more than clinicians did. Screening and consent conversations can invite those concerns instead of assuming the clinician’s list matches the patient’s.
  • Be ready to talk about the long run. The chance of response at one year was among the top drivers for both groups. Participants and referring clinicians may want to know how long a study follows people and what comes next.
  • Expect referral partners to differ. HCP preferences varied by profession, gender, and practice setting, so one message may not fit every prescriber.

Limitations to keep in mind

The survey was built with care. The team used an evidence review, steering committee input, and pilot interviews with 15 adults with TRD and 10 HCPs, and both groups answered the same questions. Still, the authors list these limits:

  • People made hypothetical choices, which may differ from real decisions about their own care.
  • The sample was U.S.-only and mostly women, so it may not reflect everyone with TRD.
  • Patients had limited experience with ketamine, esketamine, or TMS.
  • The subgroup results are exploratory. The groups were small, and no adjustment was made for running many comparisons.

Study team, funding, and citation

The study was funded by Johnson & Johnson. The research team included investigators from Washington State University, PPD Evidera Patient-Centered Research (Thermo Fisher Scientific), Johnson & Johnson, and psychiatry practices in Michigan, Ohio, and Tennessee.

The poster’s disclosures, in brief:

  • Four authors (Hamilton, Lu, Panattoni, Das) are Thermo Fisher Scientific employees who received funding from J&J to support the study. Dr. Hamilton is also a clinical professor at Washington State University, a senior medical science liaison at Tempus ATI, and a key opinion leader for J&J.
  • Dr. Whitty is a Thermo Fisher Scientific employee and minority shareholder who received funding from J&J for the study.
  • Dr. Bookhart and Dr. Milentijevic are J&J employees.
  • Dr. Amin has received honoraria for J&J speakers bureau work for esketamine.

The survey described treatments generically (oral, nasal spray, IV infusion, TMS). The poster’s reference list includes the prescribing information for esketamine nasal spray.

Citation: Hamilton J, Lu H, Panattoni LE, Das A, Whitty JA, Bookhart B, Milentijevic D, Amin R. Patient and Healthcare Practitioner Treatment Preferences for Treatment-Resistant Depression. Poster presented at: Psych Congress; September 15-19, 2026; New Orleans, LA.