Treatment Resistant Depression: The DSM-5 definition of depression is when a person feels sad, empty, or hopeless most of the time for at least two weeks. They may also lose interest in activities they once enjoyed, have trouble sleeping, feel tired all the time, have trouble concentrating, and experience changes in their appetite. Depression is different from sadness in that it is more than just a low mood; it can significantly impact a person’s ability to function in their everyday life.
Clinicians understand the stages of depression. That’s why it’s important to identify depression in the early stages before it progresses and becomes more challenging to treat. Depression is a severe medical condition that can be effectively treated with medication, therapy, or a combination of the two. Nowadays, there are additional treatment options including surgical and non-surgical solutions.
A Fresh Perspective On Treatment Resistant Depression
Psychology Today defines depression as a mental health disorder that causes a persistent feeling of sadness and loss of interest. We already know that depression can lead to physical problems such as fatigue and pain. It can also make it hard to concentrate, make decisions, or remember things. The Mayo Clinic views the severity of depression as something society should take seriously. Depression is the leading cause of disability worldwide and significantly contributes to suicide.
In each instance, depression is a debilitating mental health disorder that requires a comprehensive treatment plan. The multipronged approach for treatment resistant depression involves medication, psychotherapy, and alternative treatment options – both surgical and non-surgical options.
Treatment resistant depression (TRD) is a type of depression that does not respond to traditional forms of treatment, such as medication and psychotherapy. TRD is a serious condition that can cause significant distress and disrupt a person’s life.
There are various reasons why someone may not respond to treatment, such as having a comorbid mental health disorder or taking certain medications that can interfere with the efficacy of the antidepressant medication. TRD is a complex condition, and it is important to work with a mental health professional to determine the best course of treatment.
But Why Is TRD Such An Important Issue?
Depression is a serious mental illness that can profoundly affect a person’s life. It is estimated that at least 1 in 10 adults in the United States (U.S.) live with depression, and the World Health Organization (WHO) estimates 350 million+ people worldwide suffer from it.
- Depression is the leading cause of disability worldwide and significantly contributes to suicide.
- Suicide is now the 10th leading cause of death in the U.S., with more than 45,000+ people dying by suicide each year. [https://save.org/about-suicide/suicide-statistics/]
- Given these statistics, it is clear that we need better treatments for depression. Unfortunately, traditional antidepressant medications only work for 50-60% of people with major depressive disorder (MDD).
- This means that millions of people live with treatment-resistant depression (TRD), which can be very difficult and frustrating to deal with daily.
There are various reasons why someone may not respond to treatment, such as having a comorbid mental health disorder or taking certain medications that can interfere with the efficacy of the antidepressant medication. Therefore, TRD is a complex condition, and it is important to work with a mental health professional to determine the best course of treatment.
How Do Surgical And Non-Surgical Treatments Assist In Dealing With TRD?
There are various surgical and non-surgical treatment options available for people with TRD. These include:
- Electroconvulsive therapy (ECT):ECT is a type of brain stimulation therapy used to treat severe depression that has not responded to other forms of treatment. ECT involves passing electrical currents through the brain to induce a seizure. It is usually done under general anesthesia, and a person receives six to 12 treatments. Naturally, this surgical procedure comes with potential risks.
- Transcranial magnetic stimulation (TMS):TMS is a type of brain stimulation therapy that uses magnetic fields to stimulate nerve cells in the brain. Deep TMS™ by BrainsWay is FDA-approved to treat major depression that has not responded to other forms of treatment. Deep TMS™ is usually done on an outpatient basis, and a person typically receives five specialized treatments per week for four to six weeks. A specialized H-Coil helmet (superior to the traditional Figure-8 coil) is used to treat the patient. It is a non-surgical procedure with no long-term side effects whatsoever.
- Vagus nerve stimulation (VNS):VNS is a type of brain stimulator implant that sends electrical pulses to the Vagus Nerve, which helps regulate mood. The FDA has approved VNS as a treatment for depression that has not responded to other forms of treatment. VNS requires surgery to implant the device and can be used as a long-term treatment option. As with all surgical procedures there are potential risks involved.
- Ketamine infusion therapy: Ketamine is an anesthetic medication that can also be used in low doses to treat depression. Ketamine infusion therapy involves giving the medication intravenously over some time, usually 40 minutes to one hour. A series of six infusions are typically given over two weeks, followed by maintenance infusions every one or two weeks after that. Medical reactions may occur.
- Spravato (esketamine) nasal spray:Spravato (esketamine) is a nasal spray form of ketamine that the FDA recently approved as a treatment for depression in adults who have not responded to other forms of treatment. As with Ketamine, reactions can occur.