The Southwest Forum on Difficult to Treat Depression, chaired by Jordan F. Karp, MD, convened experts to discuss novel mechanisms, evidence-informed algorithms, and access to comprehensive depression care. Topics included advanced treatments like brain stimulation and neurosteroids, challenges in late-life depression, digital mental health treatments, and the role of biomarkers in precision psychiatry. The forum emphasized the need for equitable access and personalized medicine to improve outcomes in treatment-resistant depression.