Treatment Resistant Depression: Let's Talk.

 

Depression is a common and serious mental health condition that affects millions of lives worldwide. It can have varying degree of (from mild to severe) feelings of sadness, hopelessness, guilt, and loss of interest in activities that used to be enjoyable. Depression apart from above symptoms also does interfere with daily functioning, such as productivity at work/ school, interpersonal relationships, and difficult self-care.

While there are many effective treatments for depression, such as medications and psychological counselling, some people may not respond well to these options. This is called treatment resistant depression (TRD).

Treatment resistant depression is a term used in psychiatry to describe people with major depressive disorder (MDD) who do not respond adequately to a course of appropriate antidepressant medication within a certain time. Definitions of treatment resistant depression vary, but a common one is the lack of significant improvement after two trials of different antidepressants.

Treatment resistant depression is very frustrating for patient. It not only reduces the quality of life of patients but also increase the risk of chronicity, disability, suicide, and other medical complications.

In this blog, we will try to explain what treatment resistant depression is, what causes it, and what are various treatment options available. We will also share some new and emerging therapies that may offer hope for people with TRD who have exhausted other options.

What Causes Treatment Resistant Depression?

The exact causes of treatment resistant depression are not fully understood. However, some possible factors that may contribute to it are:

• Biological factors: Some people may have genetic variations, hormonal imbalances, inflammation, or brain abnormalities that make them less responsive to antidepressants or more prone to depression.
• Psychological factors: Some people may have co-occurring mental health conditions, such as anxiety, bipolar disorder, personality disorders, or substance use disorders, that complicate the diagnosis and treatment of depression. Some people may also have negative beliefs, coping styles, or interpersonal problems that interfere with their recovery.
• Environmental factors: Some people may face stressful life events, trauma, abuse, neglect, or social isolation that trigger or worsen their depression. Some people may also have poor access to mental health care, low adherence to treatment, or inadequate support from their family or community.

How is Treatment Resistant Depression Diagnosed?

There is no definitive blood tests or imaging for diagnosing treatment resistant depression. However, some steps that doctors take to assess the condition are:

• Reviewing or revisiting the patient’s medical history and current symptoms.
• Asking about life situations or persistent stressors that might be contributing to the depression.
• Considering the patient’s response to individual treatment regimen, including medications, psychotherapy or other treatments they have tried.
• Reviewing all of the medications the patient is taking, including nonprescription drugs and herbal supplements.
• Discussing whether the patient is taking their medications as prescribed and following other treatment steps. This will also include any premature withdrawal of medication from patient’s side.
• Considering physical health conditions that can sometimes cause or worsen depression, such as thyroid disorders, chronic pain or heart problems. An in-detail assessment is done in case of every treatment resistant depression.
• Considering a diagnosis of another mental health condition, such as bipolar disorder, which can cause or worsen depression and may require different treatment; dysthymia, a mild but long-term (chronic) form of depression; or a personality disorder that contributes to the depression not getting better. Only after this further treatment is decided.

How is Treatment Resistant Depression Treated?

Treatment resistant depression can be difficult to treat, but it is not hopeless. There are several strategies that can help improve the outcomes for patients with TRD. Some of these are:

• Medication strategies: If the first antidepressant does not work, the clinician may try increasing the dose, switching to a different antidepressant class, or adding another medication to augment the effect of the antidepressant. Some examples of augmentation agents are lithium, triiodothyronine (T3), and second-generation antipsychotics.
• Psychological counseling: Psychological counseling (psychotherapy) by a psychiatrist, psychologist, or other mental health professional can help patients with TRD cope with their emotions, thoughts, behaviors, and relationships. Some evidence-based psychotherapies for depression are cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and mindfulness-based cognitive therapy (MBCT).
• Procedures to treat depression: For patients who do not respond to medication or psychotherapy, there are some procedures that can directly stimulate or modulate the brain activity related to depression. These include electroconvulsive therapy (ECT), Esketamine nasal Spray, repetitive transcranial magnetic stimulation (rTMS), magnetic seizure therapy (MST), and deep brain stimulation (DBS). These procedures have different mechanisms of action, risks, benefits, and even high costs, and they should be carefully discussed with the clinician before trying them.
• Novel therapies: There are some new and emerging therapies that may offer hope for patients with TRD who have exhausted other options. One of the options is ketamine infusion apart from other non FDA approved treatments. These therapies are not widely available or approved for TRD yet and therefore, they should be used only under strict supervision and ethical guidelines.

What Can Patients Do to Cope with Treatment Resistant Depression?

In addition to seeking professional help, patients with treatment resistant depression can also take some steps to cope with their condition and improve their well-being. Some of these are:

• Educating themselves about their condition and the available treatment options.
• Communicating openly and honestly with their clinician about their symptoms, concerns, preferences, and expectations.
• Following their treatment plan as prescribed and reporting any changes or side effects to their clinician.
• Seeking support from their family, friends, peers, or online communities who can offer emotional, practical, or informational assistance.
• Engaging in healthy lifestyle habits, such as eating well, exercising regularly, sleeping enough, avoiding alcohol and drugs, and managing stress.
• Pursuing enjoyable and meaningful activities, such as hobbies, volunteering, learning new skills, or spending time in nature.
• Practicing positive coping skills, such as relaxation techniques, gratitude, affirmations, or journaling.
• Seeking help immediately if they have thoughts of harming themselves or others.

Conclusion

Treatment resistant depression is a complex and challenging condition that requires a comprehensive and personalized approach. Patients with TRD should not give up on finding a treatment that works for them. They should work closely with their clinician to explore different options and monitor their progress. They should also seek support from their family, friends, peers, or online communities. Treatment resistant depression can be overcome with patience, persistence, and hope. You can wats app Dr Shashank Raikwar on 9051248122.