Understanding Treatment-Resistant Depression
Struggling with depression and frustrated that your current treatments aren’t helping? You may be dealing with treatment-resistant depression.
Traditionally speaking, psychotherapy and medications is the standard for treating depression. This combination helps many people manage their depression symptoms. Of course, treating depression isn’t as straightforward as, say, mending a broken arm. It may take time and some trial and error.
For some, symptoms may improve for a while then come back. Others may not even respond to more traditional depression therapy.
These setbacks can be frustrating and make you feel even worse. It’s not an easy situation to go through...But you shouldn’t give up hope!
As we learn more about depression and how it affects individuals, we are getting a better understanding of effective ways to treat it.
Let’s take a closer look at treatment-resistant depression and what can be done about it.
What is Treatment Resistant Depression?
Treatment resistant depression (TRD) is a major depressive disorder. In general, TRD refers to not responding to at least two different antidepressant treatments.
The name of this disorder, in fact, is misleading. It may even give someone the wrong idea. TRD does not mean one cannot respond to antidepressant treatments. It means these individuals have not been matched with a treatment regime targeting their unique social and biological factors.
And TRD is probably more common than you think. By estimation, up to 33% of patients being treated for depression are eventually diagnosed with TRD.
Signs of Treatment-Resistant Depression include:
Little or no response to antidepressant medications and psychotherapy
Increased severity of depression symptoms
Longer depressive episodes
Increased anxiety
Depression symptoms return after a brief respite
Who is at Risk for Treatment-Resistant Depression?
Just about anyone with a history of depression can develop TRD. Some individuals are at a higher risk including those that are:
65 and older
Women
Have a history of substance abuse
Are dealing with chronic pain or sleep disorders
Not following their treatment regimens
Diagnosed with medical conditions like thyroid disorders, chronic pain, or heart problems
Have other diagnosed mental health conditions such as bipolar disorder or dysthymia
Ways to Treat Treatment-Resistant Depression
Medications
One way doctors and psychiatrists approach TRD is taking a closer look at an individual's medications. After all, there are a lot of factors that cause a medication to work or fail. Also, there are many options for antidepressants. It’s not uncommon for the first medication not to work as well as hoped.
In an article published by the National Institutes of Health, treatment strategies are suggested with the mnemonic SACO. Interestingly enough,”saco” means bag and Spanish. And these options allow a psychiatrist to pull from a vast “bag of tricks”.
SACO stands for:
Switching: Changing the medication if an individual doesn’t tolerate it well or the side effects are affecting quality of life.
Augmenting: Adding non-antidepressant medications when an individual has at least a partial response to an initial medication.
Combination: Using two or more antidepressant medications from different classes for a broader spectrum of antidepressant treatment.
Optimization: Increasing a medication’s dose to a standard maximum dose, as tolerated. Then monitoring an individual for 6 to 12 weeks.
There is no evidence-based order of the SACO steps, but typically optimization is the first change made to medications for TRD.
Counseling
Just like medications, there are several psychological counseling options for addressing depression and TRD. Counseling is a focused effort to help an individual find better ways to cope, communicate, manage relationships, and reduce stress. Counseling is also very helpful for individuals struggling with substance abuse.
If you tried counseling and it didn’t seem right for you, that’s okay. You may just need a different approach. For example, some individuals find support groups or group therapy more helpful. Others find switching disciplines, such as cognitive behavioral therapy, dialectical behavioral therapy, or interpersonal psychotherapy brings new perspectives and insights into their depression.
If you are not happy with your counselor or psychotherapist, consider finding one that resonates with you. Counselors are not all the same, so don’t get discouraged if you have a bad experience.
Non-Pharmacological Therapies
Over the past few decades, other therapies have evolved for those that don’t respond well to antidepressant medications.
These somatic therapies are allowing some individuals with TRD to finally get relief from their symptoms. Let’s take a look at a couple evidence-based options.
Electroconvulsive Therapy (ECT)
Under anesthesia, a carefully measured current of electricity is passed through your brain. It triggers a brief seizure that helps cause changes in brain chemistry. It’s a very effective treatment that can rapidly reduce symptoms of TRD.
ECT does have some side effects, but, in most cases, they are temporary. This can include confusion, amnesia, and cognitive impairments.
Compared to other somatic therapies, ECT is widely available. Treatments are usually done 2-3 times a week for a few weeks. Unfortunately, you will need someone to escort you to and from treatments due to the short term effects of ECT and the anesthesia.
Transcranial Magnetic Stimulation (TMS)
TMS uses an electromagnetic coil to deliver bursts of magnetic energy to a very specific area of the brain. These bursts produce tiny electrical currents in the prefrontal cortex. As a result, neurons in the brain are stimulated and reactivated.
Unlike ECT, transcranial magnetic stimulation doesn’t require anesthesia. The side effects are generally milder with no cognitive impairments.
TMS has gained popularity since 2008 when it became FDA approved to treat major depressive disorder for those adults who haven’t responded to antidepressant medications. Treatments typically last 4-6 weeks. You can go about your daily activities after receiving a TMS treatment.
Vagus Nerve Stimulation VNS
Vagus nerve stimulation uses a surgically implanted device to stimulate the vagus nerve. The vagus nerve is the crucial link between the brain and internal organs. It controls the body’s parasympathetic nervous system--the rest and digest stage when the body is not in the stressed or “fight-or-flight” response.
Electrical impulses from the device travel along the vagus nerve to the mood centers of the brain. This can help with depression symptoms.
VNS is often viewed as a last resort to treat depression and TRD, due to the costs and risks related to surgical implantation.
Seeking Help for Your Treatment-Resistant Depression
Want to know an important step in managing your treatment-resistant depression?
Finding a psychiatrist and/or counselor you are comfortable with. As you build a therapeutic trust and rapport, you’re more likely to open up and be honest about your symptoms, emotions, and personal habits.
But what if you tried other doctors and psychotherapists with mixed results?
The team at The Moment could be the change you need. You see, The Moment is not your typical doctor’s office. It’s a physician-owned and managed wellness practice. We have a full team of psychiatrists, addiction specialists, psychotherapists, and a physician’s assistant all onsite.
No need to drive around town to get the services you need. It’s all in one comfortable, modern office. And, of course, we offer virtual appointments for many of our services.
If you are looking for holistic care with a focus on mental health, you can easily book an appointment online right now!
We’re ready to work together for your positive transformation.