Therapy-resistant Depression

Therapy-resistant depression

Therapy-resistant depression (TRD) is the type of depression that doesn’t seem to respond to regular medication. These people try a variety of prescription medications and different types of therapy without seeing any improvement. But from experience we know that sooner or later they will find a treatment that will give them positive results.

This description of TRD still causes a lot of disagreement. According to the NICE (National Institute for Health and Care Excellence), it is rather an arbitrary form of diagnosis. A person is then diagnosed with treatment-resistant depression after they have tried two types of antidepressants and have not seen the desired changes.

Organizations such as The British Association for Psychopharmacology state that we can apply this diagnosis in cases where the patient has tried different combinations of medication without any change. So far, experts have not reached an agreement. But what we can say for sure is that nearly 30% of patients diagnosed with major depressive disorder experience no improvement.

In these cases, many experts feel compelled to re-evaluate their diagnosis. The fact is that sometimes there are underlying disorders that have not yet been recognized. Let’s take a closer look at this issue.

Treatment-Resistant Depression: When Medication Fails

We need to clarify one thing from the start: depression can be treated. Whatever the type of depression, this disorder is multifaceted. The therapy will therefore also be multifaceted. This means that treatment may include medication, psychotherapy, socialization, and so on.

This also applies to treatment-resistant depression. But in these cases, we need to be consistent and persistent to find the right treatment. For only then will the patient (who is suffering terribly) experience the improvement he needs.

On the other hand, we should also not forget that antidepressants have been proven to be effective. There are of course some caveats. For example, patients must take the appropriate dose for a minimum of six weeks before they see improvement.

But when there is no improvement and the patient continues to feel bad, it can be devastating. It can be even worse when he loses faith in his doctor and begins to feel skeptical about trying new treatments.

In any case, coping with treatment-resistant depression is not an easy process. This means that the treatment requires a firm commitment on the part of the patient. In addition, the support of the family is also essential.

When the treatment doesn’t work

Suppose the patient has already tried two types of antidepressants but without success. Then this is the first thing the doctor should do before drawing up a treatment plan:

  • First check whether the patient has followed his treatment (the prescribed dose and the amount of time).
  • Also check whether the patient is taking any other types of medication (prescription or over-the-counter, and including “natural” medications) that may interfere with the effectiveness of the medication.
  • Also consider other potential health problems, such as cardiovascular, neurological, or hormonal disorders.
  • Evaluate whether the patient has received the correct diagnosis. Because the reason that a major depressive disorder is resistant to treatment is often that the patient has other disorders. That could be bipolar disorder, borderline personality disorder, and so on.

The last point, but no less important, is to make sure that the patient is fully aware of their illness and motivated to make changes. We already know that chemical compounds are effective and indispensable in the treatment of depression. But we also need a certain degree of commitment on the part of the patient in order for the therapeutic process to run smoothly.

Strategies that help a person with treatment-resistant depression

One thing is now very clear. An individual suffers from treatment-resistant depression when he does not respond to treatment with medication. But what about the psychotherapeutic approach?

Isn’t this helpful in these cases? In fact, there is no conclusive research on this subject. We only know what happens when a person with major depressive disorder sees no improvement with antidepressants. This person will often also not achieve positive effects through therapy.

You should also remember that this type of depression is a serious mood disorder. So it requires psychoactive drugs. When these don’t work, health professionals usually do the following:

  • Change the dose.
  • Switching to a different kind of antidepressant.
  • Combining different types of antidepressants.
  • Improving the effectiveness of antidepressants by including other medications, such as:
    • Antipsychotics.
    • Lithium.
    • Anti epileptics.
    • Triiodothyronine.
    • pindolol.
    • Zinc.
    • Benzodiazepines.

Two Techniques for Treatment-Resistant Depression

Until recently, treatment for TRD sometimes included electroconvulsive therapy, which remains a controversial treatment. However, in recent years, two interesting therapies have come to the fore:

  • Transcranial Magnetic Stimulation (TMS) is a non-invasive and painless stimulation of the cerebral cortex. In a controlled way, it affects normal brain activity. This “neuromodulation” increases the chance that the drugs will have an effect. The individual will also be more receptive to psychological therapy.
  • Another interesting therapy is the stimulation of the vagus nerve. Several studies show that stimulation of the vagus nerve can be beneficial to treat major depressive disorder. In this method, a small electrical device stimulates the nerve that is in contact with the brain. This helps to calm the patient and reduce stress, anxiety and negative thoughts.
Therapy-resistant depression

What should I do if I suffer from treatment-resistant depression?

  • If the treatment doesn’t work immediately, don’t give up.
  • Recognize that your doctor may need to change your dose, prescribe a different medication, or try the combination of different medications. Be patient and trust your doctor and the process.
  • Remember that every case of depression is different. Your doctor needs to find a treatment that works best for you. So try to work with him or her.
  • If you are taking any other medication, be sure to let your doctor know.
  • Finally, you should protect your health and try to maintain a healthy lifestyle. Sometimes a poor diet or addiction can get in the way of treatment.

Finally, remember that even though our bodies and minds are complicated, it doesn’t mean you don’t have the right to feel good. You have the right to be free from your depression. Don’t be afraid to follow the advice of qualified professionals. Ultimately, they will find the right combination that will work for you.

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