Tuesday, July 16, 2024

How To Treat Resistant Depression

Combining Optimizing And Changing Classes

Treating Treatment-Resistant Depression

A doctor may recommend changing medications, adjusting the dosage, or switching to a different class of drug.

For example, if an SSRI or an SSNI is not effective, a doctor may prescribe an older class of drug, such as tricyclic antidepressants. An example of this type of drug is imipramine .

A healthcare professional may also add another drug to a persons medication regimen or increase their dosage.

What To Expect With A Psychiatrist

A psychiatrist may begin asking questions to learn more about you. They may be particularly interested in finding out if you:

  • also have an anxiety or personality disorder
  • smoke or use recreational drugs
  • have other chronic, nonpsychiatric conditions, such as autoimmune diseases

These conditions and behaviors are common among people experiencing treatment-resistant depression. Addressing them may improve your response to treatment.

To get a more complete picture of your health, the psychiatrist may also order blood work, such as:

  • a complete blood count
  • liver and kidney function tests
  • lipid and glucose tests
  • a thyroid test

They may also ask questions to assess the symptoms and their severity to track how these change over time.

These questions can also help determine whether the treatment resistance youre experiencing is due to an undiagnosed, underlying condition.

For example, bipolar disorder is common among people experiencing treatment-resistant depression.

You still have several options when it comes to medication for treatment-resistant depression.

What Is Treatment Resistant Depression

Treatment resistant depression is a descriptive term for the various forms of depression that dont respond to initial treatments As many as 30 to 40% of people who take antidepressants experience only partial relief of symptoms. Although some of these individuals will respond to a different medication or combination of medications, as many as 15% dont respond to antidepressant treatments at all.1

An incorrect diagnosis of depression is another possible reason for the ineffectiveness of antidepressant medications. There are some symptoms of Major Depressive Disorder which overlap with symptoms of other depressive disorders, such as Bipolar Disorder or Persistent Depressive Disorder. Once a correct diagnosis is made, the optimal medication for that diagnosis can be prescribed.

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Ketamine Is Approved For Hard

Ketamine is an unusual type of psychedelic drug called a dissociative that is undergoing a resurgence in popularity. Originally derived from PCP, or “angel dust,” ketamine has been used in hospitals and veterinary clinics as an anesthetic for decades, and has been cited as a drug of misuse under the moniker “special K.”

It is the effects that ketamine reliably produces that underlie both its medical and recreational uses: pain control, forgetfulness, intoxication, disassociation, and euphoria. Recently, it has been used more widely due to its approval for treatment-resistant depression that is, severe depression that has not improved via other therapies, including people who are experiencing suicidal thoughts.

Does Esketamine Have Side Effects


People can experience a wide range of side effects from esketamine therapy. The most dramatic are hallucinations and feeling disconnected from yourself or reality. However, side effects tend to peak at 40 minutes and wear off within two hours of treatment.

  • Nausea
  • Feeling drunk
  • Headache

If you feel treatment for depression isnt working, talk to your psychiatrist to see if esketamine therapy is an option for you.

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How To Find The Resolution To Beat Treatment

Depression is among the most common mental health illnesses, affecting nearly seven percent of adults in the United States every year. For some people, depression occurs after a major life event such as moving to a new city, an unwanted job change, losing a loved one, or going through a divorce. For others, it isnt tied to a specific event and may even be hereditary.

Of those that are treated for depression, about four out of five experience a marked improvement in their symptoms. They begin to engage with their loved ones, enjoy their hobbies, and have the motivation to function effectively at work or school.

While this is encouraging and is a great motivation for someone whos thinking about seeking treatment for their depression, it also means that about one out of five adults dont see an improvement in their symptoms.

Depression is extremely debilitating for many who live with it, and summoning the courage and motivation to take the first steps in seeking treatment can be a challenge. For someone who dutifully takes their depression medication and keeps their appointments with their mental healthcare provider but doesnt experience a break in their symptoms, depression treatment can feel like one more failed experiment. To make matters worse, the longer the depression symptoms persist, the more difficult they are to treat.

Follow The Treatment Plan

According to one study, about half of unsuccessful depression treatment is due to non-compliance. In some cases, the individual may experience unpleasant side effects from their medications. Alternately, they may stop taking their medication due to financial factors or fears of becoming dependent on it. Its important that an individual follows their treatment plan. If cost, side effects, or addiction concerns are factors, they should speak with their doctor to discuss their options.

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Why Do Some People Experience Treatment

No one knows why some people with depression get better and others dont. If you have a history of trauma or abuse, you may be less likely than others to respond to .

Researchers have also found that people with treatment-resistant depression have relatively high levels of inflammatory markers in their blood, including C-reactive protein. Brain imaging scans have shown shrinkage in certain areas that control emotional regulation such as the prefrontal cortex and hippocampus. Your depression may also be harder to treat if youre living with another chronic medical condition.

There are other reasons you may not be responding to your treatment: Your original diagnosis could be wrong. Its possible that your symptoms are caused by or another conditionnot depressionwhich would explain why the treatments arent easing your symptoms. The dose could be off as well. Sometimes, and for a laundry list of reasons, you may not be taking your medication as directedmaybe the side effects are too bothersome or perhaps its the cost of the drugs.

How You Can Support Someone With Trd

New approach to treatment-resistant depression

Social support is an important factor in helping people manage depression. It can take the form of coaches, a medical team, and professional counselorsbut friends and family can also help their loved ones cope. Depression is a medical illness and can be unpredictable and frustrating for all involved,” says Dr. MacMillan. “It should be treated the same way one would treat pneumonia or a broken leg and it is not a sign of weakness or moral failing.” As a loved one, your role isn’t to be a therapist, she says sometimes the best thing you can do is help a person connect with treatment.

If someone you care about is struggling with depression, try to have patience, says Douglas. A person may have depression for months, even yearsbut that doesn’t mean they aren’t trying to get better. Accept that they still may be struggling, even with treatment, she says. Try to get involved with the treatment process let them know they can talk about their medications with you, offer to drive them to therapy, and help them cook or grocery shop. The more you are involved, the more you can help them stay on track. Be a team at all times, she says. Friends and family of depressed people should know that they don’t have to go it alone, either. The Depression and Bipolar Support Alliance and the National Alliance on Mental Illness have local and online chapters that offer support for loved ones, says Dr. MacMillan.

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Clinical Research And Innovation

To help bring the latest procedures and treatment options to our patients, we may invite you to participate in research efforts to improve the diagnosis and treatment of depression. For example, you may be asked to participate in brief tasks that significantly improve our ability to understand a patient’s unique profile and personalize treatments for other patients better. We will always obtain your consent before asking you to participate in any of these research activities. Your clinical care at the time of the visit will in no way be affected by your decision to participate while you are here that day. In the Treatment Resistant Depression Program, we also participate in clinical trials. If you are eligible, we will tell you more about the specific study and ask if you would like to participate. These leading research opportunities are managed by some of the nation’s top scientists in the field of psychiatry and behavioral sciences.

Depression May Have Causes We Dont Yet Understandwhich May Be Why Antidepressants Dont Work For Everyone

I saw many patients with treatment-resistant depression who told me that friends and family members believed they preferred being depressed, or werent trying hard enough to improve, because their antidepressants werent working. This isnt about a lack of motivation.

Jaskaran Singh, M.D., Senior Director of Neuroscience, Janssen PharmaceuticalsShare

While the biology of depression is still largely a mystery, the most popular theory is that its caused by low brain levels of such neurotransmitters as serotonin and norepinephrine, which are associated with feelings of happiness and well-being. But recent research suggests that these neurotransmitters may not be the lone culpritso antidepressants, which work to increase serotonin or norepinephrine levels, may not be a one-size-fits-all treatment.

One of the more modern theories is that depression creates inflammation in the brain, or that inflammation in the brain creates depression, Dr. Papp says. Traditional antidepressants only affect neurotransmitters, so this may be why some patients dont respond to them.

Whether or not this turns out to be true, what we do know is there’s still no guaranteed fix for the problemwhich can be frustrating for both patients and their loved ones.

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How Can You Get Help For Your Treatment

A primary care doctor can treat depression. Research suggests that primary care doctors prescribe 60%-65% of antidepressants. But it may be best to see a specialist, like a psychiatrist, if you think you may have treatment-resistant depression. It’s also a good idea to also work with a therapist, like a psychologist or social worker. This is because the best treatment is often a combination of medicine and therapy.

Treatment-resistant depression can be hard to diagnose. Sometimes, other conditions or problems can cause similar symptoms. So when you meet with your doctor, they will want to:

Confirm your diagnosis. Some people who seem to have treatment-resistant depression have a diagnosis of unipolar depression alone. But this may not be accurate. If you have bipolar disorder, antidepressants may be less effective than in unipolar depression. And medical conditions such as hypothyroidism can cause symptoms of depression. When your diagnosis isnât accurate, itâs harder to get the right treatment.

When major depressive disorder is accompanied by other medical or psychiatric disorders such as anxiety or eating disorders, the depression often is harder to treat. This is especially true if these other disorders don’t receive their own independent treatment.

Seeking The Best Approach


You and your doctor may discuss these medication strategies for treatment-resistant depression:

Check that you’re taking your medicine as prescribed. Three in four people don’t take their medications the way their doctor recommends. Some skip a day occasionally or stop taking a drug when they start feeling better. But these moves can keep an antidepressant from working well, says James W. Murrough, MD, PhD, director of the Depression and Anxiety Center at Icahn School of Medicine at Mount Sinai. Talk to your doctor before you make any changes to the way you take your medication.

Give your current medicine more time. Antidepressants usually don’t start working right away. In general, it takes 6 to 8 weeks for them to reach their maximum effect, Murrough says. For some people, the process may take even longer.

Your body also needs to adjust to the medication. When you take a new antidepressant, you may have side effects, such as a dry mouth, headache, fatigue, or an upset stomach. But these symptoms often go away after a few weeks.

Change the dose of your medicine. People respond to antidepressants differently. You may need more or less of a drug than the standard amount. If you don’t feel different after 2 to 4 weeks, your doctor may increase your dose, Alpert says.

Most antidepressants affect chemicals in the brain called neurotransmitters, such as serotonin, norepinephrine, and dopamine. Each type of antidepressant acts on these chemicals in a different way:

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What Is Esketamine Treatment Like

Esketamine, like ketamine, has the potential to distort your perception during the first two hours after treatment, so it has to be administered in a clinic setting. Treatment for esketamine nasal spray is done on an outpatient basis.

With the nasal spray, you give yourself three doses, spaced five minutes apart, under doctor supervision. You remain in the clinic under doctor observation until potential side effects have passed.

Esketamine must be used in conjunction with a conventional antidepressant. The intention is that esketamine provides rapid relief from depression symptoms until the other medication takes effect.

What Is Lack Of Response

A treatment response in MDD is defined by a reduction of at least 50% in MDD severity on a standardised rating scale lack of response, encompassing both TRD and PRD, is the mirror image of this definition, that is, less than 50% reduction in depression severity. TRD is further associated, in most definitions, with the classic criteria of lack of response to at least two medications at an adequate dose and duration . There is, however, much variability around the definition of TRD. In a recent systematic review, Brown et al. reported that, out of 155 TRD definitions identified in the published literature, 48.4% specified at least two sequential treatment failures as a requirement. In an even more recent systematic review, Gaynes and colleagues found that only 37% of intervention studies in TRD had enrolled individuals with MDD meeting the criteria of at least two failed antidepressants, and only 19% had also described failure to adequate doses and durations of treatments. In fact, the most common definition for TRD in intervention trials involved a minimum of only one previous failed treatment . Thus, the majority of studies on TRD do not seem to use the classic criteria, making it difficult to pool or compare data across these TRD studies. Not surprisingly, there was a strong consensus for our first recommendation that a definition of TRD for clinical trials conducted for regulatory purposes is necessary.

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Its Effective For Treatment

Up to 33% of people with depression dont respond to multiple kinds of conventional antidepressants. Esketamine reduces depression symptoms in a majority of these people in clinical trials.

The only other approved drug therapy for treatment-resistant depression is a combination of olanzapine and fluoxetine . However, this treatment has significant long-term effects that include substantial weight gain, metabolic changes, diabetes and high blood pressure.

Additional Forms Of Medication Or Psychotherapy

Treating Resistant Treatment Depression with Ketamine

Finding two medication treatments to be ineffective or too severe does not mean that all psychopharmacological options are inapplicable in your case. That said, it is important to consult with a licensed medical health professional when deciding between different types of medication.

When prescribing a patient their first type of antidepressant, many mental health practitioners prefer to start them on medication belonging to the selective serotonin reuptake inhibitors family. SSRIs appeal lies in their tendency to offer safe and effective results to patients with depression. However, despite their advantages, SSRIs are not for everyone and may either insufficiently alleviate depression symptoms or cause intolerable side effects. Side effects of SSRIs may include nausea, weight gain, or sexual dysfunction. In cases like these,additional types of medications should also be considered.

Serotonin norepinephrine reuptake inhibitors are another type of medication that has been shown to offer similar levels of efficacy to that of SSRIs. SNRIs similarly tend to cause the same side effects of SSRIs, but at lower levels of severity. For this reason, patients who found the side effects of previous antidepressant treatments to be too adverse may be more inclined to consider SNRIs.

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What Medications Are Used For Treatment

Different antidepressants work in different ways to affect specific chemicals that send information along brain circuits that regulate mood. If your current medicine isn’t helping — or isn’t helping enough — other drugs might. There are two basic approaches:

Switching medicines. There are a number of different classes of antidepressants, including SSRIs, such as:

  • Citalopram
  • Tranylcypromine

One Way To Treat Treatment

Living with major depressive disorder affects every aspect of your life including how you feel, how you think, and how you behave. It can lead to a variety of emotional, physical, and social problems. MDD may impact your ability to do normal day-to-day activities including getting out of bed, brushing your teeth, and building fruitful relationships with people you love. While MDD has the ability to impact all aspects of your life, its important to remember that it does not define you and there are ways to get the help you need to improve your functioning.

If you, or someone you love, live with major depressive disorder, have tried therapy, medications, or a combination of both, and found no relief of symptoms, its possible that you may have something called treatment-resistant depression . In spite of its name, there are, in fact, ways to treat TRD. In this post, well talk about TRD and then discuss some of the treatment options available that may improve your wellness.

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