Finding a treatment that works for your depression can be a frustrating experience. The standard course of treatment for depression is to prescribe an antidepressant medication and evaluate the patient’s response. If that medication does not adequately control the depression, or if the side effects of the medication are too severe, a new prescription is issued for a different antidepressant. Rinse and repeat until either one of the medications is deemed “good enough” or the patient gives up and stops trying.
If so, you may be dealing with treatment resistant depression.
What is Treatment Resistant Depression?
Treatment-resistant depression is typically diagnosed when a patient has not responded to two different antidepressant medications of an appropriate dose taken for a sufficient length of time. A six-week period of time for each medication is considered sufficient. If a patient has not responded well after those attempts, the patient may be considered to have treatment-resistant depression. (Source)
How common is Treatment Resistant Depression?
Although the industry standard treatment for depression is to prescribe antidepressants, a surprisingly high number of patients do not respond to antidepressant medication. About two-thirds of people do not get adequate relief from the first antidepressant they try. (Source)
Each subsequent medication tried is actually less likely to work than the previous medication, sending some patients down the never-ending spiral of trying medication after medication without satisfactory result.
The number of patients with treatment-resistant depression is surprisingly large: approximately one-third of all patients with depression are classified as having treatment-resistant depression. (Source)
Is there hope for patients with treatment-resistant depression?
With such bleak statistics on treatment-resistant depression, patients may wonder whether there is any hope at all. The answer: absolutely! It is important to remember that “treatment resistant” does not mean “no treatment exists”. It merely classifies the depression as being resistant to standard treatment protocols, namely antidepressant medication.
Before we look at promising treatment options for treatment-resistant depression, it’s important to understand why standard treatment protocols do not work.
Depression is a complex condition that is still not fully understood. To some extent, depression is caused by low brain levels of neurotransmitters, such as serotonin and norepinephrine. Antidepressants – which work to increase the levels of serotonin and norepinephrine – are highly successful at treating cases of depression where low levels of neurotransmitters are the root cause.
However, research suggests that low levels of neurotransmitters are not the only cause for depression. Antidepressants are not successful at treating these cases because they address the wrong root cause.
“One of the more modern theories is that depression creates inflammation in the brain, or that inflammation in the brain creates depression. Traditional antidepressants only affect neurotransmitters, so this may be why some patients don’t respond to them.”
– Dr. Alexander Papp, MD, UC San Diego Health (Source)
Whether inflammation in the brain is eventually clinically established as a contributing factor to depression or not, it is already clear that something in addition to low levels of neurotransmitters is a contributing cause of depression. For patients whose depression has a root cause other than low levels of neurotransmitters, it is already clear that antidepressants are not the appropriate treatment solution.
Help for Treatment Resistant Depression
Because patients have a high level of familiarity with antidepressants, if antidepressants do not work, patients may conclude that nothing more can be done. Not true! There are several other treatments available to help patients with treatment resistant depression. Other available treatment options include ketamine, TMS, and ECT.
In 2019, the “S” form of ketamine received FDA approval for use as a treatment for patients with treatment-resistant depression, defined as a diagnosis of major depressive disorder with at least two antidepressant medication attempts which were unsuccessful at alleviating depression symptoms.
In clinical research, ketamine demonstrated a clinically and statistically significant decrease in depression scores. Ketamine is especially renowned for its rapid result. Whereas it can take up to six weeks for an antidepressant to take effect, ketamine is nearly instantaneous, with most patients able to start to feel the benefits of ketamine within about 40 minutes after treatment. (Source)
For patients with treatment-resistant depression, ketamine can be a game changer, delivering a rapid reduction in depression levels and helping patients regain some control over their disorder.
Transcranial Magnetic Stimulation (TMS)
TMS is one of the most promising psychiatric treatments to emerge in the past few decades. It shows tremendous promise for patients with all types of depression, but particularly for patients with treatment-resistant depression. As discussed above, antidepressants are effective in patients whose depression is a result of low levels of neurotransmitters in the brain but have little to no effect in patients whose depression has a different root cause. TMS is able to treat these patients because it uses a different mechanism and thus targets a different root cause.
TMS uses low-intensity magnetic pulses to stimulate nerve cells in the brain. Using sophisticated medical technology, a TMS technician locates and targets the patient’s dorsolateral prefrontal cortex, the area of the brain known to be impacted by depression. These magnetic pulses produce a stimulus/response in the brain, inducing the brain to generate new activity in regions of the brain that have decreased activity due to depression.
TMS is safe, effective, and well-tolerated by patients, with no systemic side effects, making it a convenient and ideal treatment for patients suffering from treatment-resistant depression.
Electroconvulsive Therapy (ECT)
ECT passes electric current through the brain to intentionally trigger a seizure. ECT requires that the patient be under general anesthesia during the treatment. ECT is effective at treating treatment-resistant cases of depression, but carries a high level of stigma because of early treatments in which high levels of electricity were used without placing the patient under anesthesia, resulting in memory loss, severe pain, and other serious side effects. The treatment was also negatively portrayed in the movie One Flew Over the Cuckoo’s Nest.
Although modern ECT treatment is much safer than it was before, because of the higher level of risk, increased side effects, and the requirement for general anesthesia, ECT is becoming less popular as TMS usage increases. Both patients and providers find TMS easier to administer, much easier for the patient to tolerate, and more convenient. Ampelis Health does not offer ECT as a treatment option.
Finding Help for Treatment Resistant Depression in Utah
If you have tried two or more antidepressants without full alleviation of depression symptoms, you may have treatment-resistant depression. For an accurate diagnosis, and to create a care plan, book an appointment with Ampelis Health today by calling 435-776-5909.