Understanding Treatment-Resistant Depression
Some people who seek treatment for their depression have little to no success with traditional methods of treatment. 30% of people diagnosed with Major Depressive Disorder (MDD) have also been diagnosed with treatment-resistant depression (TRD). MDD can be a debilitating condition that affects the individual’s daily life.
Fortunately, with the number of medications and treatment options we have today, your symptoms of depression can be treated. However, with treatment-resistant depression, you may struggle to cope with your depression through traditional means.
What is Treatment-Resistant Depression?
Treatment-resistant depression, also called TRD, is a form of depression that doesn’t respond easily to typical forms of antidepressants. In order to be diagnosed with treatment-resistant depression, an adult must first have Major Depressive Disorder (MDD). An adult also must have not responded to at least two antidepressant treatments during their depression episode.
It is extremely similar to ordinary cases of depression, though the patient may not experience the typical benefits of traditional antidepressants. In fact, most patients and their general practitioners are unaware that they have TRD.
As with other forms of depression, TRD can be found alongside anxiety disorders and other forms of mental illness. Depending on the severity of these illnesses, your depression may worsen in severity.
Who is at Risk for TRD?
Anyone can develop TRD. While there is currently no exact cause behind TRD, doctors speculate a number of factors that increase your risks of developing depression or TRD. These risk factors include, but are not limited to:
- Family history of depression
- Other underlying medical conditions
- Insomnia and other sleep disorders
- Metabolic disorder
- Bipolar disorder
- Incorrect depression diagnosis
- Incorrect type or dosage of medication
- Usage of alcohol or recreational drugs
Women are also more likely to suffer from TRD than men. While the exact reason for this is unknown, studies show that females are more likely to experience difficulties with TRD.
Signs of TRD
Because TRD can be difficult to spot, it’s important for you to know the various signs of treatment-resistant depression. If you have been diagnosed with a depressive disorder or another form of mental illness watch for signs that the treatment methods you are using are not working.
Your Anti-Depressants have Stopped Helping
Your first sign that you may be developing TRD is if your usual antidepressants aren’t as effective as they once were. It is not uncommon for antidepressants to become less effective as your body gets used to them. However, if you are showing symptoms after trying multiple forms of antidepressants or continually raising your dosage this is not normal and can be a sign of TRD.
This is not to say that you should immediately stop taking your medication if it seems to be ineffective. Many antidepressants can take weeks before they start to show benefits in their users. The best practice is to continue your regular medication regimen and report to your doctor if you experience any changes in your mood.
If you continue to find that different medications aren’t helping improve your mood, communicate this with your doctor before diagnosing yourself with TRD. Give your medications plenty of time and listen to what your general practitioner says before you give up on any of your medications.
You Experience Regular Symptoms of Depression
There are many symptoms behind different forms of depression. Depending on the exact depressive disorder you have, you may experience various symptoms caused by your mental illness. If you start experiencing your typical symptoms, then you may be developing TRD.
In people with bipolar depression ordinary antidepressants may be able to treat some of the depressive symptoms, but not all of them. If you enter into a manic episode, your antidepressants may not be able to help. If you begin experiencing other symptoms alongside your usual depression, you should report them to your doctor or therapist right away.
Additional mental illnesses won’t improve with antidepressants alone. Focusing only on your depression could cause your other illnesses to worsen, which may increase your symptoms of depression. Over time, you may develop treatment-resistant depression due to the neglect of your other mental illnesses.
Talk with your doctor about all of your mental illnesses while deciding on a treatment plan for your depression. That way, you can decrease your chances of developing TRD.
Treatment Options for TRD
Those suffering from TRD struggle to find appropriate ways to cope or treat their mental illness. However, there are still options for you. If you are concerned you are developing or have developed TRD, talk with your doctor about more treatment options.
Antidepressants can take up to eight weeks to be fully effective, so it is important to give the medication time to work. Your doctor may suggest a higher dose of the medication you are currently on because people respond differently to medications.
Sometimes, your doctor may prescribe another type of antidepressant in addition to the one you are currently taking. The goal with this additional medication is to affect a wider range of neurotransmitters in your brain that are linked to your mood.
Your doctor may ask you to consider pharmacogenetic testing to help prescribe the right antidepressant for you. These tests check for specific genes that show how well your body can process a medication.
Psychological counseling, otherwise known as psychotherapy, can be a powerful tool in helping an individual find recovery from their depression. Psychotherapy can help you find ways to cope with daily life struggles, process emotional trauma, manage your relationships in a healthy way, and learn how to better deal with stress.
There are many different types of psychotherapy that help to treat depression:
- Cognitive Behavioral Therapy (CBT) – Type of counseling that addresses thoughts, feelings, and behaviors that affect mood. This helps identify negative thinking patterns and teaches you skills to respond to life’s problems.
- Dialectical Behavior Therapy (DBT) – Type of counseling that helps you build problem-solving skills and acceptance strategies to help with your mental health.
- Acceptance and Commitment Therapy (ACT) – A type of therapy that encourages patients to accept their emotions and feelings. These mindfulness techniques are used in hopes that the person will accept all aspects of their lives.
- Interpersonal Psychotherapy – This is an evidence-based approach commonly used to treat mood disorders. This type of therapy is used to help the patient with their interpersonal relationships.
- Family or Marital Therapy – Therapy with the people who have influences on your mental health can be beneficial to help others around you understand your disorder.
- Group Psychotherapy – Group therapy can be used to help people with depression develop new skills and get support from their peers.
Additional Treatment Options
For some individuals, therapy and medication for their depression are not enough. There are additional alternative methods that are available for people who have treatment-resistant depression.
Esketamine is an FDA-approved treatment for people with TRD. This medication is an intranasal treatment usually given in a doctor’s office and under the supervision of a medical professional. The medical professional should supervise you for two hours after your initial dose.
The effects of the medication can last days or even weeks following the treatment. Over time, the medication will be administered less until the patient is weaned off completely. Esketamine is often used in addition to other forms of oral antidepressants.
Electroconvulsive therapy, or ECT, is a procedure where electric currents go through the brain . The patient is put under general anesthesia for the entirety of the procedure. The electric currents result in a controlled seizure that tends to affect neurons and neurotransmitters in the brain.
This procedure is usually repeated four to six times before any improvement is seen in the patient’s depression. ECT can have potentially negative side effects like confusion, memory loss, and headaches. There are potential side effects connected to ECT treatments, so talk with your doctor in detail about it before making your first appointment.
Vagus Nerve Stimulation (VNS)
Vagus Nerve Stimulation, or VNS, is an FDA-approved treatment for people with TRD. A surgeon wraps a wire around the vagus nerve in your neck. Then, a device is implemented into the chest and connected to the wire in your neck.
The vagus nerve is stimulated by the device and sends electrical bursts to the brain stem. From there, the signals are transmitted to the mood center of the brain, which alleviates feelings of depression. This is a more invasive option and requires surgery to relieve your depression symptoms.
Repetitive Transcranial Magnetic Stimulation (rTMS)
Transcranial Magnetic Stimulation (TMS) is an FDA-approved treatment for TRD. This is a non-invasive procedure that helps to stimulate regions of the brain linked to mood. TMS typically stimulates the prefrontal cortex in the frontal regions of the brain where people with depression have low activity.
During treatment, a specialized electromagnetic coil is placed on the patient’s head where it is then used to deliver gentle repetitive magnetic pulses. This stimulates these targeted regions of the brain and strengthens the pathways that are associated with mood and well-being. As a result, levels of neurotransmitters in the brain can normalize (i.e. serotonin, dopamine, norepinephrine, etc.).
TMS treatment is usually administered five days a week for 4-6 weeks. Sessions last anywhere from 15 to 45 minutes depending on the protocol being used and the patient’s individual needs.
Because the TMS procedure is free of medications and doesn’t require anesthesia, patients most commonly report little to no side effects and can drive home safely after their treatment.
With this guide to treatment-resistant depression, you can find a treatment option that works best for you. There are alternative treatment options to antidepressants so that TRD does not control your life. These methods include vagus nerve stimulation, electroconvulsive therapy, esketamine, and transcranial magnetic stimulation.
At Brain Therapy TMS, we offer individualized TMS treatment for patients struggling with TRD. If you or a loved one is struggling with treatment-resistant depression, please contact us with any questions or concerns you have about treatment options.
- Bowers, E. S., Patel, R. B., Upham, B., Pugle, M., Vaughn, L., Migala, J., Parch, L. A., Marks, J., Hurley, K., & Doheny, K. (2021, August 6). 12 signs your antidepressant isn’t working. EverydayHealth.com. Retrieved January 21, 2022, from https://www.everydayhealth.com/depression/signs-your-antidepressant-isnt-working.aspx
- Brown, J. (2020, February 3). 4 things we now know about treatment-resistant depression. Content Lab U.S. Retrieved January 21, 2022, from https://www.jnj.com/health-and-wellness/4-facts-about-treatment-resistant-depression
- George, M. S., & Aston-Jones, G. (2010, January). Noninvasive techniques for probing neurocircuitry and treating illness: Vagus nerve stimulation (VNS), transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tdcs). Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology. Retrieved January 21, 2022, from https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC3055429/
- Health. (2016, February 29). 3 signs you should stop, adjust, or switch antidepressants. Health.com. Retrieved January 21, 2022, from https://www.health.com/condition/depression/3-signs-you-should-stop-adjust-or-switch-antidepressants
- Hirschfeld, R., & Weissman, M. (2002). Risk factors for major depression and bipolar disorder – ACNP. American College of Neuropsychopharmacology. Retrieved January 21, 2022, from https://acnp.org/wp-content/uploads/2017/11/CH70_1017-1026.pdf
- Jaffe, D. H., Rive, B., & Denee, T. R. (2019, August 7). The humanistic and economic burden of treatment-resistant depression in Europe: A cross-sectional study – BMC psychiatry. BioMed Central. Retrieved January 21, 2022, from https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-019-2222-4
- NAMI. (2022). ECT, TMS and other brain stimulation therapies. NAMI. Retrieved January 21, 2022, from https://www.nami.org/About-Mental-Illness/Treatments/ECT,-TMS-and-Other-Brain-Stimulation-Therapies
- NIMH. (2021, October). Major Depression. National Institute of Mental Health. Retrieved January 21, 2022, from https://www.nimh.nih.gov/health/statistics/major-depression
- U.S. FDA. (2019, March 5). FDA approves new nasal spray medication for treatment-resistant depression; available only at a Certified Doctor’s Office or clinic. U.S. Food and Drug Administration. Retrieved January 21, 2022, from https://www.fda.gov/news-events/press-announcements/fda-approves-new-nasal-spray-medication-treatment-resistant-depression-available-only-certified