What to Do About Treatment-Resistant Depression
Depression has been referred to as the “common cold” of mental health disorders, affecting about one in five adults in the U.S. in any given year. The mainstays of treatment for this debilitating condition are cognitive behavioral therapy and medication. Unfortunately, up to one-third of the people with depression don’t get better with these interventions. These individuals are said to have treatment-resistant depression (TRD) or refractory depression.
If treatment-resistant depression has left you in despair, do not give up hope. One option is to go to rehab for depression, where your doctor may change your medication or augment what you’re currently taking with another drug such as an atypical antipsychotic (Abilify, Zyprexa and others). In low doses, these medications have been proven to help relieve TRD symptoms, so don’t be put off by the scary-sounding name. Other depression therapy techniques like neurofeedback, repetitive transcranial magnetic stimulation (rTMS) and electroconvulsive therapy have also been shown to help. Some people have chosen to go a more experimental route, using ketamine as a depression treatment. Below you’ll find more information about each of these options.
#1 Rehab for Depression
You’ll receive around-the-clock care at a treatment facility that specializes in depression therapy. Through intensive individual and group therapy, you’ll get the chance to dig deeper than you may have in the past into what may be fueling your depression. If you’ve turned to substances to cope, rehab will give you the opportunity to detox as well as learn new, healthy coping tools to manage your moods. Depending on the depression rehab you choose, treatments may include such experiential and holistic therapies as acupuncture, massage, yoga, equine therapy, psychodrama and many others.
This noninvasive, painless therapy allows people to learn how to regulate their moods by controlling their brainwaves. Sensors are placed on the scalp to allow you to see your brainwaves in real time on a video screen. Through brain-training exercises, you learn to change your brain’s function. The goal is to lower certain brainwave frequencies while increasing other, healthier frequencies.
#3 Repetitive transcranial magnetic stimulation
rTMS is another noninvasive depression treatment that involves using a magnet to activate certain areas of the brain. During rTMS, an electromagnetic coil is placed near the area of the brain that regulates mood. The coil passes magnetic pulses to the targeted area, which creates an electrical current in specific nerve cells. These electrical currents stimulate brain cells in a way that has been shown to reduce depression. Comedian Neal Brennan, co-creator of “The Chappelle Show,” says rTMS “did more for my depression than anything I’ve ever done.”
#4 Electroconvulsive therapy
ECT is performed under general anesthesia and is an effective therapy for treatment-resistant depression. With ECT, electrical stimulation is delivered to the brain that causes a brief seizure. For reasons doctors don’t fully understand, the seizure helps relieve the symptoms of depression. ECT works rapidly, making it a potentially lifesaving treatment for individuals at risk of suicide. And remember that ECT today is a far cry from its crude beginnings in the 1940s. In fact, the National Institute of Mental Health (NIMH), the American Medical Association and the American Psychiatric Association endorse ECT as an important depression therapy.
Ketamine has been used for decades as a general anesthetic in surgery. Although it has not been approved by the FDA for the treatment of depression, ketamine is being used in clinics across the country as an “off-label” treatment. The drug is administered via IV or intramuscular injection as the individual relaxes in a quiet room. A landmark study by a team from the NIMH found that a single dose of ketamine produced “robust and rapid antidepressant effects” within a matter of hours. Other studies have shown that ketamine can reverse the kind of stubborn depression that traditional medicines often don’t touch.
If you have been suffering from treatment-resistant depression, don’t for a moment think your situation is hopeless. Focus on the word resistant. No one is an impossible case. With time and effort, you can find a therapy that works for you. Experts say maintaining a positive, hopeful attitude can be as critical as getting the right treatment.
Nearly one in five adult Americans experienced mental illness in 2013. https://www.samhsa.gov/newsroom/press-announcements/201411200115
Repetitive Transcranial Magnetic Stimulation. https://www.healthline.com/health/depression/repetitive-transcranial-magnetic-stimulation#overview1
Randomized Clinical Trial of Real-Time fMRI Amygdala Neurofeedback for Major Depressive Disorder: Effects on Symptoms and Autobiographical Memory Recall. http://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2017.16060637
A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression. https://www.ncbi.nlm.nih.gov/pubmed/16894061
Onetime party drug hailed as miracle for treating severe depression. https://www.washingtonpost.com/national/health-science/a-one-time-party-drug-is-helping-people-with-deep-depression/2016/02/01/d3e73862-b490-11e5-a76a-0b5145e8679a_story.html?utm_term=.e856ddb91b5f
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