Feeling down from time to time is a normal part of life. We all experience moments of sadness, depression, and hopelessness. When these feelings, however, last for weeks, months, or years, that’s a clear sign of depression.
Many people struggling with depression have found treatment in the forms of medicine and therapy to help. There are others who’ve tried these treatments and found they did very little to improve their depression symptoms.
Treatment-resistant depression is depression’s darker twin. Those diagnosed with it experience many of the same symptoms and feelings as other forms of depression. The main difference is treatment-resistant depression doesn’t respond to traditional treatment.
Do have treatment-resistant depression or know a friend or family who does? The good news is you can still overcome many of the symptoms of this type of depression. Here’s how you can live with treatment-resistant depression.
Understanding Treatment-Resistant Depression
Treatment-resistant depression can affect anyone. It’s very similar to other forms of depression but it doesn’t respond well to traditional forms of treatment.
Most individuals and their doctors don’t know they have treatment-resistant depression. Most don’t know until they find out their antidepressant medication doesn’t work.
Those at greater risk for treatment-resistant depression include those who have:
- A history of depression
- Underlying medical conditions
- Sleep disorders
- Bipolar disorder
- Older (senior citizens)
- Genetic factors
- Metabolic disorder
- Had depression for a long time
- Had an incorrect diagnosis
Other potential causes include symptom severity and anxiety. Depending on the severity of symptoms, you can have mild, moderate, or severe depression. Those with severe depression have a greater risk of developing treatment-resistant depression.
As the name suggests, treatment-resistant depression doesn’t improve with traditional forms of treatment. What can you do if you have this type of depression?
When Medication Doesn’t Work For Depression
The most common treatments for depression include antidepressants and psychotherapy. While many people respond well to either one or both treatments, about 30%-40% didn’t see any improvement with treatment.
Fortunately, there are effective treatments for treatment-resistant depression. Common treatments your doctor might recommend include:
- Changing the drug class of antidepressant medication
- Combining antidepressants
- Rapidly-Acting Treatments
Your doctor may recommend one or a mix of all three of these treatments.
Combining & Changing Drug Class of Antidepressants
There are several different drug classes of antidepressant medications. The first, and most commonly used class, is selective serotonin reuptake inhibitors. These improve symptoms of depression without as many side-effects as other antidepressants.
Your doctor may prescribe an antidepressant in another drug class. Another option is your doctor may prescribe two different antidepressants for you to take simultaneously.
If this isn’t enough, there are more aggressive medications such as lithium, antipsychotic medications, dopamine, and medications. Adding nutritional supplements to your diets, like fish oil, zinc, or folic acid may also help.
The challenge with antidepressants is they can take weeks to work. Those with severe depression can have suicidal behaviors which make this type of depression far more life-threatening. Waiting several weeks for an improvement isn’t always an option.
Rapidly-acting treatments for treatment-resistant depression (RAPID) is a research project by the National Institute of Mental Health. Its purpose is to develop fast, safe, and effective treatments for those experiencing treatment-resistant depression.
Fast-acting treatments include ketamine and electroconvulsive therapy (ECT) can work, they often come with side-effects. Both require a hospital setting and ketamine often causes patients to relapse after treatment.
There are more RAPID options available. Here are a few newer treatments as well as ones still in the research phase.
Transcranial Magnetic Stimulation (TMS)
Transcranial Magnetic Stimulation, sometimes known as repetitive TMS or rTMS is a neurophysiological technique that stimulates parts of the brain. TMS uses magnetic stimulators to activate parts of the brain. While it first emerged in 1985, it wasn’t until 2008 that the FDA approved TMS as a treatment for depression.
TMS works by placing an electromagnetic coil against the forehead. The short electromagnetic pulses pass from the coil through the skull to stimulate nerves in a specific part of the brain. The currents can reach about 2 inches into the brain.
This treatment is non-invasive, doesn’t require anesthesia, and is nearly painless. The few side effects some experience is a slight discomfort on their head and tingling of their face muscles during the procedure.
Electroconvulsive Therapy (ECT)
ECT is a treatment option for those experiencing severe treatment-resistant depression, bipolar disorder, or schizophrenia. ECT works much faster than antidepressant medication and older patients respond well.
ECT uses electrodes placed on the patient’s head to pass an electric current through the brain. This causes a short seizure, usually less than a minute. This procedure requires anesthesia and muscle relaxants to prevent pain and movement.
Typical ECT treatments require around 6-12 treatments or until the patient’s depression improves. Common side-effects include headache, memory loss, upset stomach, and muscle aches. With unilateral ECT, there are fewer side effects including memory issues.
Vagus Nerve Stimulation (VNS)
Originally developed for treating epilepsy, VNS uses the left vagus nerve to send electrical pulses. These pulses affect the part of the brain that regulates mood. The electrical pulses affect the production of neurotransmitters including serotonin, glutamate, and norepinephrine.
A doctor must implant a small generator in the upper left side of the chest. An electrical wire travels from the generator up to the Vagus nerve. About every 5 minutes, the generator will send 30-second pulses through the wire to the nerve and brain.
You can deactivate the device using a magnet before exercising as it can affect breathing. It will reactivate once you remove the magnet.
A few side-effects of this treatment include neck soreness and sore throat. Others have reported discomfort around the device location and breathing problems. Most people, however, don’t experience any side effects with VNS.
Treatment-Resistant Depression is Treatable
Depression is a tough experience. Learning you have treatment-resistant depression can make life feel impossible.
Fortunately, you can improve your quality of life, even with treatment-resistant depression. Want to learn more about the treatments available? Request a free consultation to learn more about TMS and how it can help improve your life.