Let us start at the very beginning. What is treatment-resistant depression? As you might have guessed by the name, it is a kind of major depressive disorder with lingering depressive symptoms despite trying at least two antidepressants at a proper dosage and duration – for at least 6-8 weeks. When your symptoms persist despite the efforts you are making, treatment-resistant depression (TRD) may be a possibility.
Why Do Some Struggle With TRD – Even With Treatment?
Antidepressants are some of the most powerful medications for depressive symptoms out there. So, you might be wondering when they work for many, and effectively so, why do some struggle in spite of them? Johns Hopkins Medicine says that one in three persons (30%) diagnosed with major depressive disorder (MDD) struggles with TRD.
This does not mean you are doing anything wrong. Many factors, like genetic predispositions and brain chemistry, can make MDD harder to treat. In fact, researchers have also suggested that chronic stress can change the function of the brain’s hypothalamic-pituitary-adrenal (HPA) axis, complicating this treatment.
Recognizing TRD: What Are the Symptoms of Treatment-Resistant Depression?
TRD is similar to major depressive disorder – characterized by persistent sadness, emptiness, and worthlessness. Here are some symptoms of TRD you may experience:
- Low mood
- Sleep disturbances
- Changes in the appetite
- Longer, repetitive depressive episodes
- Anhedonia – inability to enjoy the things you once loved.
- Suicidal thoughts and ideation.
If this sounds like something you or a loved one is experiencing, please know that TRD is not the end of the road. Help is always available for you.
How Is Treatment-Resistant Depression Diagnosed?
Put simply, TRD is diagnosed when your depressive symptoms have not improved despite using at least two different first-line antidepressants such as SSRIs, SNRIs, Bupropion, and Mirtazapine.
By reviewing medications, psychotherapy sessions, and other conditions like bipolar disorder, personality disorder, substance use disorder, and even chronic pain, licensed and trained mental health practitioners may diagnose a person with treatment-resistant depression.
So, What Is the Best Treatment for Treatment-Resistant Depression?
Coming to the key point – what is the best treatment for treatment-resistant depression; can it be treated at all? Indeed, yes. There are more advanced, effective options available now, more so than ever.
Psychotherapy
Psychotherapy is not the sidekick when it comes to treating depression; it is the cornerstone of the treatment. Working regularly with your therapists can be the breakthrough you need in your struggles with depression, even if it is TRD.
Rethinking Medication Strategies
If the traditional medications are not working, then it may be time to rethink medication strategies. Currently, the U.S. Food and Drug Administration (FDA) approves the following five medications for TRD:
- Aripiprazole
- Brexpiprazole
- Olanzapine
- Quetiapine
- Esketamine nasal spray.
Alternative Brain and Body Interventions
Electroconvulsive Therapy (ECT) – ECT is one of the most effective treatments for TRD, even the most severe form of TRD, where life-threatening risks are involved. Carefully controlled current is passed through the brain to trigger a seizure – which can be relieving.
Transcranial Magnetic Stimulation (TMS) – An insulated coil is placed over the head, which is used to generate brief and painless magnetic pulses by focusing on those regions in the brain that are involved in mood regulation.
Deep Brain Stimulation (DBS) – DBS surgically implants wires inside the brain, which are then connected to a tiny, stimulating device under the collarbone. DBS interrupts those irregular signals that give rise to depressive symptoms, but it is only used for severe cases of TRD.
Ketamine
Ketamine is an anesthetic drug that provides relief from TRD symptoms within just a few hours. Ketamine is given either by injection or the esketamine nasal spray we mentioned before.
Psilocybin
You might know psilocybin as the psychedelic compound found in magic mushrooms, which gives rise to hallucinogenic effects. When administered in a safe, controlled environment, it can reduce depressive symptoms among those with TRD. However, it has not been approved by the FDA until now.
Key Takeaways
- What is treatment-resistant depression? Treatment-resistant depression, or TRD, does not respond to at least two different first-line antidepressants.
- Why does it happen? Genetics, brain chemistry, and chronic stress can lead to TRD.
- What are the best treatment approaches? Psychotherapy, different medication combinations, ECT, TMS, DBS, and ketamine/esketamine are considered as best treatment options for TRD.
- Is there hope for healing? Yes, many best paths exist toward relief and healing.
Reach Out Today – Let Skyline Be Your Partner In This Journey
Depressive symptoms and depression can vary from person to person; what may ease depressive symptoms in one person may not be as effective for the other. But this does not mean you give up. There are more treatment options available now than ever before – treatment options that offer relief and hope.
If you are ready to explore advanced therapies and treatment options, reach out to Skyline Recovery at (424) 353-5206 for a free consultation today. Let us find a way forward, together.