Getting diagnosed with depression is bad enough, but having a form of depression that doesn’t respond to standard treatment options can feel hopeless. When talk therapy and medications don’t work, what options are people left with? Luckily, it’s not as hopeless as it may seem. With some patience and effort, it is possible to find a treatment that works. After all, it’s treatment-resistant depression, not treatment defiant depression. Just think of your depression as extra stubborn, it will just take a little more work to alleviate it.
Treatment-Resistant Depression is most commonly defined as a Major Depressive condition. It’s when an individual’s depression has not responded to at least 4 different antidepressants, including any medications that are from more than one antidepressant category. These individuals also don’t respond to psychotherapy.
Some people with treatment-resistant depression do respond to antidepressants, but the side effects of the medication are so severe that they end up doing more bad than good. If medication worked once before but now stops working, that would also be considered a medication failure.
You may roll your eyes and say, “another one?” It can take time, often through trial and error, to find the right medication, dose, or combination to combat someone’s depression. Doctors will always start by trying out newer antidepressants, like Prozac, Celexa, and Zoloft, and or maybe even Effexor, Cymbalta, and Wellbutrin. Try every medication before moving on.
Sometimes the older ones work when the newer ones don’t. Antidepressants like TCAs or MAOIs are always an option. These drugs do work, but doctors are always hesitant to prescribe them, as they tend to have severe side effects. Not everyone will get the side effects though so they are worth a try if newer medications have failed.
Antidepressants aren’t the only type of drug that can fight treatment-resistant depression. Sometimes psychiatrists will try using antidepressants and then add another type of medication to help. This type of treatment is called add-on or augmentation therapy. Drugs like lithium, anti-anxiety drugs, anticonvulsants, and antipsychotics are often used to augment antidepressants. The only drawback to add-on therapy is that the more medications one person takes, the more likely they are to experience side effects.
Talk therapy along with medications is one of the first approaches that any psychiatrists will recommend for someone with treatment-resistant depression to try. Therapy is successful in being especially helpful with this type of depression. Cognitive-behavioral therapy (CBT) has been particularly successful. The best type of therapy though is the one that feels right to the patient. Don’t be afraid to try out different therapy styles or psychiatrists until you find one that fits.
Transcranial Magnetic Stimulation (TMS) has been shown to have huge effects on those with treatment-resistant depression. It’s a form of brain stimulation, where doctors use magnetic pulses to stimulate targeted areas of the brain to relieve symptoms of depression. TMS for depression treatment has been proven to be very effective, with minimal side effects. Our partner clinic, Delray Center for Brain Science, offers this form of therapy.
There are other forms of brain stimulation, like Electroconvulsive Therapy (ECT), but TMS has a few pros over ECT. For one, the procedure is completely painless. Patients don’t even have to have sedation or hospital admittance. The side effects and risks are minimal too. A headache is the most common symptom of TMS therapy.
Ketamine is now a party drug; due to the out of body feeling and hallucinations the drug creates. However, it was originally an anesthetic. Today, researchers are looking into how the drug can benefit people beyond a good time or knocking them out. Ketamine doesn’t have FDA approval to treat depression, but all research shows promising results.
Ketamine acts more effectively and quickly to reduce symptoms of depression, even treatment-resistant depression. People report feeling better in days, or even hours, after a ketamine treatment, whereas regular medication can take weeks or months to start working. It’s not a miracle drug, but with results this promising, it’s worth looking into for those that have severe symptoms and no other option has worked on their depression.
Getting a diagnosis of treatment-resistant depression isn’t the end. There are still options out there for people to try. The key is to stay optimistic. There will be some treatment out there that will work. It takes time and patience to just figure it out. If you would like to know more about any of these treatments or want to book an appointment please feel free to contact us.
Since 2003, the Delray Center for Healing has provided exceptional psychiatric and therapeutic care for mental health, eating, and substance use disorders. To learn more about our philosophy and treatment approach, download our free e-book, “Psychiatry Redefined,” written by our founder and medical director, Raul J. Rodriguez, MD.