Treatment Resistant Depression is a serious condition that causes significant individual and societal burdens. Effective management of this refractory depression can lead to substantial benefits. If antidepressants aren’t helping, it’s important not to give up. Instead, work with a psychiatrist to find a new approach that may include different medications and/or therapy.
While primary care doctors write most antidepressant prescriptions, people with Treatment Resistant Depression need to see a psychiatrist for medication advice. Psychiatrists have advanced training in prescribing medications. They may change the dosage or switch to a different drug. They can also prescribe other treatments, such as ketamine. This is a fast-acting medication that improves depression symptoms and is usually given through an IV in small doses. It is also available as a nasal spray. Another treatment option is deep brain stimulation, which involves implanting a device that sends electrical currents to the brain. Talk therapy can also be helpful. Some types of talk therapy include dialectical behavioral therapy, which teaches skills for problem-solving and acceptance strategies to address issues such as chronic suicidal thoughts or self-injury. Other forms of psychotherapy can help, too, such as psychodynamic psychotherapy, which encourages understanding of underlying problems and past traumas that contribute to depressive symptoms. Family and group psychotherapy can also be beneficial for some individuals. Changing medication could include switching to a new drug in the same class, adding a non-antidepressant medicine to the regimen, or trying a different type of antidepressant altogether. One recent Treatment Resistant Depression option is esketamine nasal spray. This new drug quickly relieves depression symptoms in about half of people who get it. It works by affecting multiple serotonin receptors in the brain and isn’t a typical antidepressant. Psychiatrists also have a range of other medications to prescribe, including the antidepressants bupropion, mirtazapine, and vortioxetine, as well as antipsychotics like olanzapine and fluoxetine. They can also try augmentation strategies, such as adding a stimulant like methylphenidate or modafinil, or combining an SSRI with a second-generation antipsychotic. They may also use a combination of different augmentation and other therapies, such as neurostimulation or psychotherapy. If there has been no relief from antidepressants, talk to a doctor about trying a new therapy option. A psychiatrist may recommend augmentation therapy. This involves adding a second drug to the first-line medication, and it is usually not an antidepressant. Examples include lithium (Priadel), a mood-stabilizing drug doctors also use to treat bipolar disorder; triiodothyronine, a synthetic thyroid hormone that can affect depression; and quetiapine, an antipsychotic. Researchers are also exploring innovative therapies for treatment-resistant depression. One receiving a lot of attention is psilocybin combined with psychotherapy, which has shown promise in people with treatment-resistant depression. Another option is repetitive transcranial magnetic stimulation, which uses electromagnetic coils to stimulate nerve cells in the brain involved with mood control. There's also a nasal spray called Spravato that contains ketamine, which has recently been approved by the FDA for Treatment Resistant Depression. This medicine relieves symptoms within a few hours, whereas it isn't for everyone. A doctor will weigh the risks and benefits with the patient. Changing lifestyle and thinking can have a profound effect on the mood. It is important to stay active and get enough rest. It is also find healthy ways to manage stress. It is important to avoid activities that make an individual depressed, like self-injury or alcohol abuse. Along with making lifestyle changes, Options MD team may recommend other holistic treatments that can help. This includes cognitive behavioral therapy (CBT), which teaches new coping skills, and dialectical behavior therapy (DBT). DBT helps people learn to accept their feelings and thoughts rather than avoiding or judging them. It can also be helpful for people who catastrophize, which is a common symptom of depression.
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