When Medication Doesn’t Work for Depression…
For many different reasons, depression remains a hot topic of conversation. This serious mental health disorder affects millions of people around the world. The World Health Organization (WHO) estimates that some 5% of adults (18+ years of age) suffer from depression on a global scale. The demographics on depression are skewed towards adults who are 60+ years of age at 5.7% globally. Psychology Today lists multiple treatment options for depression, notably antidepressant drugs, psychotherapy, brain stimulation (neuromodulation), and surgical procedures indicated in the treatment of depression.
The most commonly prescribed treatment for depression is medication. Various classes of drugs are used, including selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Zoloft, Luvox, Lexapro, and Celexa. Another class of antidepressant medication is known as selective and norepinephrine reuptake inhibitors (SNRIs) such as Cymbalta, Pristiq, Fetzima, and Effexor. Tricyclic antidepressants (TCAs) have more side effects and include the likes of Trofanil, Asendin, Pamelor, and Surmontil. The atypical antidepressants are used for treatment-resistant depression and include Wellbutrin and Remeron. Another category of drugs for early-stage treatments include monoamine oxidase inhibitors (MAOIs) such as Nardil and Emsam.
Qualifiers: If Symptoms Of Depression Persist, It Could Be TRD
Major Depressive Disorder (MDD) is notorious because of its treatment-resistant nature. When drugs are administered to patients suffering from MDD, a response may or may not be forthcoming. A response in medical terms is indicated by a 50% reduction of depression symptoms. That in itself is an insufficient qualifier for an effective treatment. When patients suffering from depression are anxiety-ridden even on medication, this can adversely impact brain functionality. Lingering symptoms of depression can propagate additional episodes of depression in the future. This all but guarantees that the patient will regress into another depressive episode. For depression to be considered treatment-resistant, multiple treatments must be tried. Regular doctor visits are necessary to assess the efficacy of each specific depression treatment, in varying doses.
NIH (National Library of Medicine) experts Blumberger, Daskalakis, and Voinkeskos wrote a research paper titled, ‘Management of Treatment-Resistant Depression: Challenges and Strategies’. The abstract of the article referenced Major Depressive Disorder (MDD) as being difficult to treat with first-line therapeutics. In addition to pharmacological augmentation strategies, patients underwent somatic therapies. These include repetitive transcranial magnetic stimulation, deep brain stimulation, magnetic seizure therapy, electroconvulsive therapy, et al. Even ketamine – a new age therapeutic was tried on patients with treatment-resistant depression with various ketamine clinics becoming available around the world.
What Do We Know About Treatment-Resistant Depression?
Treatment-Resistant Depression (TRD) references major depressive disorder, which is in itself a collection of unique types of depression. Johnson & Johnson published an article titled, ‘4 Things We Now Know About Treatment-Resistant Depression‘ in April 2018. There is no widespread consensus on precisely what constitutes TRD, but at least two types of antidepressant medications must be tried for a significant period (up to 6 weeks) to qualify. Based on the numbers, we know that senior citizens and females tend to experience a higher degree of treatment-resistant depression than men. Of course, there is evidence to suggest that men tend to eschew treatment for depression or procrastinate when it comes to seeking help.
Given the complexity of mental health disorders and MDD in particular, there is no guarantee that medication works for every malady. Generally accepted theories on this topic suggest that low levels of serotonin and norepinephrine may be associated with poor neurotransmitter activity. Extensive studies indicate that neurotransmitters are not the only cause of depression, offering that antidepressants in and of themselves would not necessarily cure the condition. If – as new-age theory suggests – brain inflammation causes depression, then it makes sense that antidepressants are of little practical help.
Treatment-Resistant Depression (TRD) can be combated in various ways. There are a variety of somatic therapies that do not require any medication whatsoever. These alternative treatment regimens include surgical and nonsurgical options. The surgical options include electroconvulsive therapy (ECT) which is a lot safer than our cultural zeitgeist suggests. Other options include deep brain stimulation (DBS), and Vagus Nerve Stimulation (VNS). The nonsurgical alternatives include transcranial magnetic stimulation, notably Deep TMS™. A specialized coil is used to transmit electromagnetic waves to stimulate neural activity in the affected areas of the brain. It is noninvasive, non-surgical, and safe. The efficacy of such treatments is equally encouraging.
In summary, depression can certainly be resistant to medication. Every person is different, and so we react differently to chemical substances. Sometimes, the root cause of depression is incongruous with the treatment being offered. It’s especially important to thoroughly evaluate each patient on his or her merits. The best treatment plan may be a cocktail treatment including therapy, medication, and somatic treatments too.