What is Treatment-Resistant Depression?

What is Treatment-Resistant Depression?

Those who have been diagnosed with depression have no shortage of treatment options—but even so, depression is difficult to overcome for a staggering number of people. Even though antidepressants are the second most commonly-prescribed drug in the United States, an estimated 30{2997f8544d703ffd995cbf0748d9148f9150b33c2eb54c93a5197645ffc3f066} of people who try them still can’t seem to shake their symptoms. And unfortunately, people with depression are less likely to find an antidepressant that works after several medications have failed.

If you have tried multiple antidepressants prescribed by your doctor but you are still experiencing symptoms of depression, such as constant sadness, feelings of emptiness, insomnia, and fatigue, you may have treatment-resistant depression (also called refractory depression). If this is the case, it doesn’t mean your depression cannot be treated—it just means that your depression does not respond quickly to standard treatment.

If you have treatment-resistant depression, you may want to see a psychiatrist in addition to your primary care physician. A psychiatrist can help figure out the underlying cause of your depression, consider other physical factors which can contribute to depression, and review the medications you’ve tried so far to help you figure out what to try next. You may also want to consider getting a cyctochrome P450 genotyping test. Everyone processes medications a little differently, and this test can help your doctor figure out if your body may have trouble metabolizing certain kinds of antidepressants.

There are a number of changes your doctor may recommend to your treatment regimen if you have treatment-resistant depression. He or she may increase the dose of your current antidepressant, switch you to a different antidepressant, or have you take another medication in addition to your current antidepressant. This could be a mood stabilizer, such as lithium—which is known to be effective for both depression and bipolar disorder, although it can cause side effects.

You may also try an older antidepressant. Tricyclic antidepressants (TCAs) and Monoamine Oxidase Inhibitors (MAOIs) may not be your doctor’s go-to drug choices because of their serious side effects, but they can be effective when others have failed. Or your doctor may suggest a new antidepressant, Symbax, which combines Prozac with an antipsychotic. Symbax is the first FDA-approved drug specifically for treatment-resistant depression.

You may also try a treatment that isn’t a drug at all. Electroconvulsive therapy (ECT) is a brain stimulation therapy in which electrodes send an electrical current through the brain to induce a mild seizure. Since the patient is given a muscle relaxer beforehand and put under anesthesia, the procedure is safe—however, it can cause short-term memory loss for several weeks or months.

Another brain stimulation therapy you may try is transcranial magnetic stimulation (TMS). A study presented at the annual meeting of the American Psychiatric Association in 2015 found that TMS works well for moderately to severely depressed patients with treatment-resistant depression. The researchers analyzed hospital data for 37 patients with major depressive disorder and melancholia (persistent feelings of sadness and hopelessness). The patients had all tried at least two antidepressants, without success. The researchers found that most of the patients improved after about 15 TMS sessions. TMS can also be taken as an add-on treatment in addition to your current medications—many patients who try TMS continue taking antidepressants.

In addition to medications and brain stimulation therapies, many people also find it helpful to try psychotherapy (also called “talk therapy”) to work through depression. This may sound simple, but talk therapy is more than just talk—there are many different types, each with its own distinct method.

One of the most common forms of talk therapy used to treat depression is cognitive-behavioral therapy (CBT). CBT is all about action—you work with your therapist to identify the negative underlying thoughts and behaviors that could be contributing to your depression, then figure out positive thoughts and behaviors to replace them. Psychodynamic therapy, which helps patients become more aware of emotions and put them in perspective, as well as interpersonal therapy, which focuses on social interactions, can also help. If you haven’t tried any form of talk therapy yet, you may want to give it a shot—a combination of therapy and medical treatment may work best for combatting depression.

TMS Neuro Institute is one of the earliest adopters in using transcranial magnetic stimulation to treat depression in Los Angeles. To schedule a consultation, call 888.823.4867 or book an appointment online here.