If you have symptoms of depression that have persisted during the course treatment, then you may have treatment-resistant depression. Many people with treatment-resistant depression (TRD) feel that they have failed in treatment and that their situations are hopeless, which can worsen the severity of their depression. If you have TRD, don’t blame yourself. You many have more treatment options than you realize.
TRD can be defined as depression that is resistant to common treatment options, which usually includes psychotherapy and one antidepressant. If you have tried at least two different classes of antidepressants at different times with little improvement, then your depression is likely treatment resistant. Ask your doctor about additional medical treatments that are available to you. All medications and medical procedures have some risks, so discuss the risks and the potential benefits with your physician.
Your doctor will first need to determine if you truly have TRD. He or she may ask if you have been taking your current medications as prescribed. Your physician may also ask if you have been using alcohol or other drugs that may have hindered the effectiveness of your medications. Your doctor may want to rule out physical problems that could be partly responsible for your depression.
If your doctor determines you have TRD, he or she may choose to replace your current medication with a different antidepressant. An increased dose of your current medication is another option your doctor may consider, but do this only with your doctor’s consent. Your doctor may want to combine your current antidepressant with another medication from a different family of antidepressants. Augmentation (combining your current antidepressant with a different type of psychiatric medication) has also been effective in some patients with atypical depression.
Refractory depression treatment should include a comprehensive plan that combines medications and psychotherapy. This combination is usually the most effective approach in treating depression. People recovering from TRD may consider supplementing individual psychotherapy with group therapy or support groups. Family therapy and couples counseling are often helpful in resolving conflicts and family problems that worsen depression.
If depression persists through psychotherapy and several medication trials, additional options remain. Consult with a psychiatrist to determine if other medical procedures would be appropriate for you.
According to the American Psychiatric Association (APA), electroconvulsive therapy (ECT) is safe and effective when administered by “properly qualified psychiatrists for appropriately selected patients.” Today, ECT is pain-free and administered after a general anesthesia. A small amount of electricity is delivered to the brain to induce seizure activity, lasting about 40 seconds. Medicine prevents the seizure from spreading through other parts of the body. ECT is usually completed after six to 12 sessions, with two to five days between sessions.
Vagus nerve stimulation (VNS) involves a surgical procedure in which a pulse generator is implanted in the patient’s chest. A wire is placed under the skin to connect the pulse generator to the left vagus nerve of the neck. The pulse generator sends electrical signals along the vagus nerve to the brain, with the intention of affecting the brain’s mood centers.
VNS is a controversial form of treating drug-resistant depression and there is no guarantee that it will be effective. Researches are divided about its effectiveness for the treatment of depression. Some insurance companies refuse to pay for this procedure.
Deep brain stimulation (DBS) has been described as a pacemaker for the brain. A neurostimulator is implanted in the chest and electrodes are implanted in the brain. Wires run under the skin, connecting the neurostimulator to the electrodes, sending electrical signals that affect the brain’s mood centers. Although the Food and Drug Administration has approved DBS in the treatment of Parkinson’s disease, more research is required to prove that it is effective for refractory depression treatment. A study published by Biological Psychiatry suggests that DBS provides significant improvements that are sustained for one year or longer. The study claims that DBS is relatively safe and that the procedure is well tolerated.
Many patients who are being treated for depression have symptoms that persist. If you are still battling depression after a considerable amount of time and effort in treatment, now might be the time to talk with your doctor and therapist about additional treatment options.