Treatment-Resistant Depression

If you’ve been treated for depression but your symptoms haven’t improved, you may have treatment-resistant depression. Although antidepressants and talk therapy are treatment options for depression, over half of patients still experience symptoms after trying these conventional treatments.

What is treatment-resistant depression (TRD)?

Most clinicians agree that treatment-resistant depression (TRD) can be described as failure to achieve and sustain euthymia with adequate anti-depression treatment. A patient is often considered to have TRD if they have tried an adequate dose of at least two types of antidepressants and have not seen significant improvement.

Treatment-resistant depression symptoms can range from mild to severe and may require trying a number of approaches to identify what helps. This might include different antidepressants, therapy, and other treatments. If you’re still struggling with depression despite treatment, here’s what you need to know.

Which risk factors have been associated with treatment-resistant depression?

If you or a loved one suspect you may have TRD, it’s important to confirm a proper diagnosis. Some people with bipolar disorder, substance use disorder, or thyroid disease are misdiagnosed with TRD. A medical evaluation can also rule out important comorbidities including pancreatic cancer, hormonal etiologies like low testosterone and perimenopause or possible deficiencies in Vitamin B12, Folate and Vitamin D.

For those diagnosed with TRD, there is no single cause. However, TRD has been associated with several different risk factors. The following factors may increase a person’s risk of experiencing TRD:

  • Long depressive episode duration
  • Mild or very severe depressive episode
  • High number of stressful life events and traumas
  • Melancholic features including lack of reactivity to positive news and events, feelings of deep despair or worthlessness, weight loss and excess guilt
  • Advanced age
  • Genetic variants including those within the serotonin transporter-lower transporter transcription alleles (SLC6A4)

Can precision prescribing help treatment-resistant depression?

There are a lot of different antidepressants and it can be difficult to predict how well a particular medication will help an individual. Often, doctors first suggest taking a medication that they consider to be effective and relatively well-tolerated. If it doesn’t help as much as expected, it’s possible to switch to a different medication and sometimes a number of different antidepressants have to be tried before you find one that works. Currently, this trial-and-error prescribing of antidepressants is a contributing factor in treatment failure.

Precision prescribing uses genetic information to help patients avoid the trial-and-error process. With precision prescribing, DNA samples are taken with cheek swabs and sent out to a laboratory. The results may help clinicians and patients rule out medications that, for genetic reasons, will be less effective or that may lead to more side effects.

Studies have shown that patients with treatment-resistant depression are 30% more likely to respond to treatment and 50% more likely to achieve remission when their medication selection is guided by a psychotropic genetic test.

Are there safe and effective treatment alternatives for treatment-resistant depression?

There are many safe and highly effective treatment alternatives for those with TRD. The goal of depression treatment is always to achieve full remission. Patients with TRD should not have to tolerate lingering symptoms or side effects. Treatment alternatives for depression include:

Transcranial magnetic stimulation (TMS)

Transcranial magnetic stimulation (TMS) is a safe and effective treatment for depression that uses magnetic pulses to stimulate specific areas of the brain responsible for mood. TMS is non-invasive (does not require surgery), non-systemic (does not affect the entire body), covered by most insurance and has no drug-related side effects. Typically, patients experience symptom relief with TMS is just two weeks.

Since its FDA clearance in 2008 for depression and 2018 for OCD, studies have suggested TMS may also be a promising treatment for a range of other mental health conditions. Notably, TMS is a safe and effective treatment option for anxiety, OCD, cognitive impairment and smoking cessation.

IV Ketamine

Although ketamine has been used safely as an anesthetic since the 1960s, the discovery of ketamine as a highly effective and rapid-acting treatment for a wide range of treatment-resistant mood disorders has been hailed as arguably the most significant development in psychiatry during the past few decades.

While existing antidepressant medications take up to several weeks to exert their effects, one dose of ketamine has been shown to have a greater response rate within a matter of hours. Although IV ketamine is FDA-approved as an anesthetic, it is used off-label to treat mood and chronic pain disorders. At the present time, ketamine infusions for mood and chronic pain disorders are cash pay procedures.

Magnetic E-Resonance Treatment (MeRT)

MeRT therapy is a treatment that combines the technologies of repetitive transcranial magnetic stimulation (rTMS, an FDA cleared therapy), qEEG and EKG to deliver treatments tailored for each individual’s unique brain pattern.

By measuring and analyzing your brainwave activity, MeRT assesses the communication quality between the neurons in your brain and custom designs treatment protocols to optimize brain function. Using neuroscience and machine learning, MeRT visibly reshapes brainwave activity and strengthens functionality to improve health outcomes.

Don’t settle for a treatment that’s partially effective at relieving your depression or one that works but causes intolerable side effects. To learn more about precision prescribing at Neuro Wellness Spa or other treatment options for depression, call or contact our expert clinical team today.

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