Depression is usually managed with medication, therapy, or a combination of the two, and symptoms usually improve with treatment. However, sometimes symptoms do not improve with typical treatment.
Although definitions vary, when two or more treatment attempts with adequate doses and duration fail to provide the expected relief, the disorder may be considered "treatment-resistant depression."
Treatment-resistant depression can be complicated. Symptoms of depression, such as sleep problems and appetite problems, may continue despite the patient's compliance with treatment. Other times, symptoms improve for a short time but come back.
It's important to remember that even if depression doesn't respond to the first few treatments, that doesn't mean it can't be treated. However, it may require a different approach to treatment. You should work with your doctor to monitor your symptoms and response to treatment so you can find an option that works for you.
Prevalence
Studies show that 30% to 40% of people experience only one symptom of depressive symptoms after taking antidepressants. He found that he experienced a partial recovery. 1 About 10% to 15% of people do not respond to antidepressant treatments at all.
For people with treatment-resistant depression, the consequences can be significant. It is associated with poor social functioning, medical comorbidity, and increased mortality.
Untreated depression is also a common cause of disability, so it is important to continue finding strategies that can bring relief. The lifetime risk of suicide in untreated depression is between 2% and 15%.
Symptoms
Treatment-resistant depression can manifest as:
- Reliance on medication or No response to psychotherapy treatment
- No adequate response to standard depression treatments
- Return of depressive symptoms after brief improvements
Standard treatments do not work or do not work at all Because it doesn't work, people can begin to feel deep despair. Symptoms can last for months before you feel any relief or mood improvement.
Causes
Doctors and researchers aren't exactly sure what causes treatment-resistant depression. Some theories are: � includes:
- Genetics: Researchers believe that hereditary traits may play a role in how people's bodies respond to different antidepressants. While some genes have been associated with treatment-resistant depression, more research is needed to identify genetic biomarkers. 2
- Misdiagnosis: Poor response to standard depression treatments can also occur when people are misdiagnosed with depression. While they may have symptoms of major depressive disorder, they may actually have a different condition, such as bipolar disorder.
- Metabolic abnormalities: Some studies have suggested that metabolic disorders and nutritional deficiencies may play a role in treatment-resistant depression. For example, one study found that folate (vitamin B9) deficiency was more common in people with treatment-resistant depression. More research is needed in this area to determine the full impact of metabolic conditions.
Diagnosis
If you have been treated for depression but your symptoms have not improved, you should talk to your doctor. Treatment-resistant depression is not a formal diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and is not consistently defined. Some experts suggest it's defined as having been tried two different antidepressants without relief, while others suggest it may take up to four different treatments for depression to be defined as persistent.
In any case, you should always talk to your doctor about your symptoms and concerns. If you haven't experienced any relief, only minimal relief, or a complete return of symptoms, you may need a different antidepressant or other approaches to your treatment.
Your doctor may:
- Treatments you've tried so far review
- Consider the type of response you have to treatments
- Assess your current physical health and consider underlying medical conditions
- Consider diagnosis of other psychiatric disorders
- Consider other medications and supplements you currently take
If your doctor believes you have treatment-resistant depression, he or she may recommend a different dosage, medication, or treatment approach. Your doctor may also refer you to a psychiatric counselor for additional treatment recommendations and options.
Treatment
Although estimates vary, anywhere from 30% to 50% of patients with depression respond to a particular antidepressant medication. It is believed that it may not give. Before considering a medication a treatment failure, a physician or psychiatrist will consider the following questions:
- How long was the medication administered? Most antidepressants take four to six weeks to work . Before declaring a treatment not working, providers will want to make sure the medication has been used long enough to be effective.
- How closely has the patient adhered to the prescription? A prescription is generally considered “adhered” only if it is taken according to the prescription a significant percentage of the time. Missed doses can greatly affect a medication's ability to be effective. Therefore, before determining whether a medication has failed, a doctor will want to know whether a patient is complying with it. Sometimes doctors count pills or take other steps to monitor a patient's medication.
- Is the medication in a therapeutic dose? Sometimes medications are started at a low dose to minimize risk or side effects. The dose can be increased slowly as tolerated. A physician will want to ensure that the dosage is at a therapeutic level before determining whether treatment has failed.
Medications
A psychiatrist may consider whether your current medication is a failure. If he finds that it is, there are other treatment options that affect the brain chemistry in a different way.
Psychotherapy
If you are not already participating in psychotherapy, you may add psychotherapy to your treatment.
Other Treatment Options
When medication and therapy do not reduce depression, your doctor may consider other treatment options. You may decide to pass. Some additional procedures that may be effective for treatment-resistant depression include:
Recurrent transcranial magnetic stimulation (rTMS):
Electroconvulsive Therapy (ECT):Perhaps the most effective treatment for resistant depression is ECT. ECT is a procedure performed under general anesthesia. Electrical currents pass through the brain, triggering a brief seizure. It appears to cause changes in brain chemistry that may reduce depression (and reverse symptoms of other mental illnesses). GECT is usually administered two to three times a week initially. Treatment duration may vary, but total between six and 12 sessions.
Vagus nerve stimulation (VNS): VNS is a surgical procedure that involves implanting a pacemaker-like device into the body. It is connected to a stimulating wire that runs along the vagus nerve, which is thought to affect an area of the brain that regulates mood. Once implanted, the device sends regular impulses to the brain via the vagus nerve. It may take a few months for the effects to be felt.
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