I Now Know I Have Treatment
I took a leave from my job and ultimately quit because I felt the pressure wasnt good for my mental health. It was around this time that I started hearing about treatment-resistant depression . It really resonated with me.
Technically speaking, having TRD may mean you have not responded adequately to at least two different antidepressants of the adequate dose and duration in the episode of depression you’re currently having. Thatscertainly been the case for me. I might have a honeymoon period where an antidepressant works for a while, but then it stops helping. So I try something new. And then try something else. And Im not alone: About one-third of adults with major depressive disorder battle symptoms ranging from sadness to suicidal thoughts that traditional treatments aren’t able to resolve.
Borha today
Understanding that I have TRD has actually been very positive. Its made me think of my depression as a chronic illnesssomething I have to try and actively manage. Ive stopped expecting to find one perfect medical solution or life experience thats going to heal me.
First Antidepressant To Receive A Breakthrough Status Designation
Janssen requested and received a Fast Track designation from the FDA for Spravato based on the belief that the drug fills an unmet need in a serious medical condition. According to Sandy Walsh, an FDA spokesperson, Spravato is the first antidepressant with a Breakthrough Therapy designation to be approved, and only the second drug to be approved for treatment-resistant depression.
Once a drug receives the Fast Track designation, early and frequent communication between the FDA and a drug company is encouraged throughout the entire drug development and review process. The frequency of communication assures that questions and issues are resolved quickly, often leading to earlier drug approval and access by patients.
Prospective Or Retrospective Assessment
A related issue, particularly important for regulatory clinical trials, is whether one treatment failure should be prospective within the trial, i.e., the trial starts with an established medication for MDD at an adequate dose, and then the person is offered a new intervention only if the medication fails to improve or eliminate MDD symptoms. We acknowledge that this, while ideal, would lead to operational execution challenges within a trial, with increased complexity and burden for the sites and study participants .
We recommend that it is possible to assess ineffective past/current antidepressant treatment attempts, but only if properly documented, that is, based not only on subjective recollection or standardised instruments to assess psychiatric history and previous treatments , but also on clinical documentation, such as pharmacy, hospital, or other health records. This documentation can also be used to confirm some degree of adherence to the failed treatments, and to screen people with depressive symptoms for previous episodes of mania, hypomania, or sub-threshold bipolarity, since these individuals should be excluded .
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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.
Experts Explain The Reasons Medication Doesn’t Always Work And What You Can Do About It
As if depression wasnt insidious enough, allow us to introduce you to its fickle, evil twin: treatment-resistant depression . A major depressive disorder, TRD describes depression that has failed to respond to at least two different antidepressant treatments. Anyone who has experienced depression knows how inescapable and hopeless it can feel. TRD compounds that problem, making it difficult for patients to find a treatment that offers lasting relief.
You might imagine thats pretty rare, right? Wrong. Up to one-third of adults with major depression battle symptoms that dont get better with treatment. Many people struggle to find the medication thats right for them, while others never respond to your standard antidepressants. According to Alexander Papp, MD, a psychiatrist at UC San Diego Health, only 30-35% of patients respond to the first antidepressant theyre prescribed.
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Traditional Treatments For Depression
Over the last decades, researchers and clinicians have come up with numerous strategies and approaches for treating depressive disorder.
From a psychiatric perspective, depression results from a chemical imbalance in the brain. In order to restore the neuro-chemical balance, psychiatrists often prescribe antidepressants like tricyclic antidepressants, monoamine oxidase inhibitors and selective serotonin reuptake inhibitors .
Another approach that clinicians use to treat severe depression is electroconvulsive therapy . This involves passing small-intensity electric currents through the brain under general anesthesia.
As for psychotherapy, many experts believe that cognitive-behavioral therapy is ideal for treatment resistant depression. In fact, a recent study revealed something interesting about this type of psychotherapy. It showed that hope and emotional processing are two crucial elements through which CBT practitioners can improve the chances of recovery for people with chronic forms of depression.
Operational Criteria For Trd And Prd
Based on a number of guidelines and other expert documents , in this report we adopt the definition of TRD as indicating individuals who show a reduction of less than 25% in MDD severity to at least two antidepressants, and of PRD as indicating individuals who show a reduction of between 25% and < 50% in MDD severity to at least one antidepressant. This should ideally be established using prospective psychometric assessments, or at least using clinical interviews and health records to measure retrospectively the improvement in depression severity .
The majority of experts, even though with moderate consensus , recommended the importance of this distinction between TRD and PRD for randomized clinical trials for new treatments, especially because of the potential advantage of separating these individuals for different types of randomized controlled trials .
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How To Know If Youre Finally Improving
Its important to also know the signs that indicate youre heading in the right direction. Healing from treatment-resistant depression can be a slow process for many, but its important to take note of small improvements.
As someone improves, we would want to see their sleep stabilize, and maybe their appetite and energy increase, Posey explains. Or theyre having the ability to get up and do the things that they enjoy doing.Whatever treatment or therapy option you choose, treatment-resistant depression affects every person a little differently. So, its important to take note of how your mental health is changing and how it may require new solutions. Talk to your psychiatrist or healthcare provider to learn more about the best treatment options for you.If you or someone you know needs help, reach out to a mental health expert or connect with a resource or support group, such as:
There Are Established Methods For Managing Treatment
While the words treatment-resistant might seem synonymous with no hope, the reality is that tools do currently exist to help people with TRD. A 2012 study published in the journal Patient Preference and Adherence identified five main treatment strategiesoptimization, switching, combination, augmentation and somatic therapiesthat psychiatrists can use to create a personalized plan for patients.
Optimization, for instance, means that some people with TRD may benefit simply from giving their antidepressant more time to work or by taking a larger dose, Dr. Papp says.
For others, switching to a different class of antidepressantor adding one to the current treatment for a combined approachmay lead to remission. And augmentation may involve using medications that were developed for other uses, but that have since been approved for the treatment of TRD.
Transcranial magnetic stimulation can be an effective nondrug treatment for TRD
There are also somatic therapies, including transcranial magnetic stimulationwhich targets nerve cells in the region of the brain involved in mood control and depressionand electroconvulsive therapy , which induces changes in brain chemistry to help reverse symptoms of TRD.
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Dosage And Duration Of Antidepressants
Most studies and meta-analyses have found no benefit for antidepressant dose escalation versus staying on the minimum licensed dose, with an increased risk of side effects and discontinuation , even if there is also evidence that higher doses may have superior efficacy and that higher starting doses may be associated with higher response rates . In terms of minimum duration, some studies have shown that, while two weeks can be enough to observe an initial response, a stable response/remission is usually detectable after four weeks . However, a complete remission may not be detectable after four weeks. For example, approximately half of remitters on citalopram in level 1 of the STAR*D trial remitted between week 6 and week 14 . Of note, this is different for fast-acting medications, such as esketamine , but these drugs are indicated for individuals that already have TRD.
We recommend that the criteria of adequate dose and duration is the minimal effective dosage, that is, the minimal approved dosage, administered for at least four weeks.
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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When Depression Treatments Dont Work
When standard treatments dont work, clinicians often consider two possibilities. Either they misdiagnosed the patient, or theyre dealing with a case of treatment resistant depression.
Although the term treatment resistant might sound worrying and discouraging to many of us, it doesnt mean that were out of options.
But the question is, why do some people experience this form of depression?
A Different Mechanism Of Action That Acts Fast
Esketamine works in a different way than traditional antidepressants, says Kamiya. Spravato works on the N-methyl-D-aspartate receptor, an ionotropic glutamate receptor in the brain. The medicine is administered as a nasal spray that is absorbed by the lining of the nasal passages and into the blood stream.
Esketamine is derived from ketamine, a widely used anesthetic. In the 1980s and ’90s it was known as a club drug, called Special K, that people used for its hallucinogenic effects. In the last few years, intravenous delivery of ketamine has grown increasingly popular in treating depression in clinics around the country. However, this version and method of treatment is not approved for treatment-resistant depression and generally not covered by health insurance.
I believe esketamine will be more efficacious in treating depression than the ketamine intravenous medication. Esketamine is better at targeting the NMDA receptor than ketamine, says Kamiya.
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Naomi Judds Death Puts Focus On Treatment
May 03, 2022
Country music superstar Naomi Judd, who died Saturday at the age of 76, said she spent a lifetime battling severe, treatment-resistant depression. In interviews over the years she was candid about her battle with suicidal ideation, panic attacks and her mental health struggles.Her daughters Wynonna and Ashley Judd said they had lost their mother to “the disease of mental illness.” Although no official cause of death has been made public, sources told People Magazine that Judd died from suicide.Judd revealed she was diagnosed with treatment-resistant severe depression during in an interview with ABCs Good Morning America in 2017.Treatment-resistant because they tried me on every single thing they had in their arsenal, she said. “It really felt like, if I live through this, I want someone to be able to see that they can survive.”Judd said she spent stints in psychiatric wards during her mental health struggles.”I had to go into serious treatment, and it was a long road an incredibly painful road. There were times when I didnt think I was going to make it,” Judd wrote in a 2017 essay.According to Mirjana Domakonda, MD, Director, Clinical Trials Unit, Hartford Hospital and Institute of Living, treatment-resistant depression is a clinical diagnosis defined by an inadequate response to at least two antidepressant treatments of adequate dose and duration in patients with major depressive disorder.
Summary Of Results Obtained
Four open ended questions were asked in the survey. The results of which have been outlined below and discussed in the next section.
The first narrative question stated, could you mention any specific ways in which you used kinesthetic empathy in your work? Four participants alluded to interoception, three mentioned rapport development and two participants mentioned using kinesthetic empathy as a pathway to regulation.
The second narrative question stated, in your experience, how do clients respond to kinesthetic empathy in dance/movement therapy sessions? Four participants named observable responses and four participants named perceived client-felt emotional responses to kinesthetic empathy in dance/movement therapy sessions.
The third narrative question stated, please specify how you are able to attribute any mentioned changes to kinesthetic empathy? Five participants mentioned client self-report to attribute observed and emotionally felt responses to kinesthetic empathy. Three survey participants mentioned clinicians observation of movement pathways in their clients as a plausible link between the observed changes noticed by therapists and kinesthetic empathy.
The narrative responses have been discussed in four categories in the Discussion section below.
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The Reality Of Living With Treatment Resistant Depression
Members of the Champalimaud Research Neuropsychiatry Unit have recently been involved in several real-life evidence studies to examine how Treatment Resistant Depression can affect the lives of those suffering from this surprisingly common condition.
The studies are available to access through the following links, with a third paper currently under review:
Prolonged Grief Is Now Recognized As A Mental Health Condition
In Canada, symptoms of depression are on the rise. In the spring of 2021, a quarter of Canadians over the age of 18 screened positive for symptoms of depression, anxiety or post-traumatic stress disorder , compared to one-fifth in fall 2020, according to Statistics Canada . Just over one-fifth of depression cases are considered resistant to treatment which is defined by a lack of response to two separate classes of antidepressant medications.
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When Antidepressants Dont Work: Living With Incurable Depression
For the majority of people, a combination of medication, counseling and neuro therapy effectively treats their depression. Other people may experience depression as a cloud that always hovers, no matter what treatments they try.
For the handful of people who truly have treatment-resistant depression, looking for a cure may be the wrong approach. Rather than seeking to totally eliminate every symptom of depression, a more realistic and productive goal may be to learn how to manage the symptoms of depression and achieve the best outcome possible.
Those who havent had success in treating depression may benefit from seeking help from an experienced mental healthcare professional. While primary care doctors can prescribe antidepressants, for many people, this is just one aspect of effective treatment. A mental healthcare professional that utilizes more comprehensive treatment plans and has up-to-date knowledge on state-of-the-art therapies may be able to better help individuals achieve their desired outcomes.
Current Or Past Episodes
The preferred definition of TRD for clinical trials includes a current failure and a past failure, i.e., subjects are currently receiving an antidepressant and they are still depressed according to current clinicians assessment, and they were also treated with another antidepressant in the past and showed no response based on retrospective assessment. However, it is unclear whether both of these treatments should apply to the same episode or to clearly distinct episodes. Indeed, although the EMA definition of MDD emphasizes the current episode for the characterisation of the disease, it does not clarify whether the two failures should both be during the current episode. Of course, it is difficult to retrospectively defining the response to an antidepressant, especially if the current episode is of long duration and the previous treatment was closer to the onset of the episode.
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