دارودرمانی و رواندرمانی رایجترین روشهای درمان افسردگی هستند که به طور قابل توجهی به کاهش علائم این اختلال کمک میکنند. با این حال، بدن و ذهن برخی افراد به روشهای استاندارد درمان افسردگی پاسخ قابل انتظاری نمیدهند. روانشناسان معتقدند فرد در چنین شرایطی به افسردگی مقاوم به درمان مبتلا شده که برای بهبود آن به رویکردهای ترکیبی و روش درمان پیشرفتهتری نیاز است. In this article from the health magazine of Dr. Keihani Fard's neurology clinic, we will introduce you to the cause, symptoms, and the newest treatment for treatment-resistant depression.
What is treatment-resistant depression?
Treatment-resistant depression (TRD) is a type of major depressive disorder (MDD). This disorder is diagnosed when a person has taken at least 2 antidepressants in the first line of treatment with an appropriate dose and for a sufficient period of time, but the main symptoms of depression have not disappeared.
In fact, we must say that resistant depressive disorder can develop in people who were previously treated with antidepressants. Fortunately, contrary to the name of this disorder, there are currently various treatment methods to improve it, and the best option is chosen by a mental health specialist according to the individual's condition.
Symptoms of treatment-resistant depression
Symptoms of treatment-resistant depression (TRD) are similar to major depression and often include depressed mood, appetite changes, and sleep disturbances. With the difference that people with TRD are more likely to experience the following:
- More severe symptoms
- Longer periods of depression
- Decreased ability to experience pleasure
- Number of more depressive episodes during life
- Anxiety
- Suicidal thoughts and behavior
Quote:
Approximately 30% of people who have been diagnosed with MDD and who have tried medications for MDD have treatment-resistant depression. MDD is one of the most common mental health conditions. It affects 5% to 17% of people at some point in their lives.
Approximately 30% of people diagnosed with major depressive disorder and receiving medication have treatment-resistant depression. Major depressive disorder is one of the most common mental illnesses. This disease affects 5 to 17 percent of people at some point in their lives.
Quoted from clevelandclinic
The cause of treatment-resistant depression
Currently, researchers do not know the main cause of treatment-resistant depression. They believe that, just as various factors such as genetics and brain chemistry may cause major depressive disorder, they are also effective in causing TRD.Also, mental health experts believe that chronic stress may play a role in the occurrence of treatment-resistant depression by changing the function of the hypothalamus-pituitary-adrenal (HPA) axis. The HPA axis is responsible for adapting to stress and is one of the most important processes in the body. Disruption of this process leads to TRD; Therefore, it can be said that chronic stress plays an effective role in worsening depression and can make it more difficult to treat.
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What are the risk factors of resistant depressive disorder?
Some research has shown that people with TRD are more likely to have physical problems such as the following than people with major depressive disorder who are not resistant to treatment:
- Cerebrovascular disease
- Autoimmune disease
- heart disease
- thyroid disease
How is treatment-resistant depression diagnosed?
Treatment-resistant depression is diagnosed when a person's depression symptoms do not improve after taking at least 2 first-line antidepressants.
Medications that a mental health specialist prescribes as the first line of treatment for depression symptoms include the following:
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- selective serotonin and norepinephrine reuptake inhibitors (SNRIs) Bupropion Mirtazapine
The doctor usually prescribes first-line depression medication for 6 to 8 weeks to see if the symptoms decrease. If the person's symptoms do not improve after trying 2 first-line antidepressants, the patient will be referred to a psychiatrist.
Mental health specialist examines all the drugs used, including prescription drugs, non-prescription drugs, herbal supplements and non-medical drugs. Because some drugs can aggravate the symptoms of depression or interfere with antidepressants. Then, questions are asked about whether or not the patient has taken prescribed antidepressants according to the instructions, has had psychotherapy experience, and what was its effect.
In the next step, the psychiatrist checks if there are co-occurring disorders such as severe anxiety, bipolar disorder, personality disorder, substance abuse disorder, thyroid problems, chronic pain, and vitamin deficiency; Because these problems can reduce the effectiveness of antidepressants. After examining these cases, the mental health specialist may diagnose treatment-resistant depression and help to choose the best treatment option for the patient.
What is the treatment of drug-resistant depression?
There are different ways to treat TRD. Finding the best treatment may take some time; So don't lose hope. The psychiatrist usually starts the treatment with the following methods:
- Gives your current antidepressant more time to see if it's working.
- The dose of antidepressant increases the first line of treatment.
- He prescribes another group of antidepressants so that you take 2 different types of medicine at the same time.
- Recommends to continue psychotherapy under the supervision of a psychologist.
If these strategies are not effective, the psychiatrist may prescribe a combination of other drugs. It should be noted, avoid changing the type and dose of medicine arbitrarily and without consulting a psychiatrist; Because this can cause serious side effects.
If the previous treatments did not improve your depression, start a new treatment!
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In addition to the above, the US Food and Drug Administration (FDA) has approved the following treatments for TRD, the best option should be chosen by a neurologist:
1- electroshock therapy (ECT)
Shock therapy (ECT) is one of the effective methods of improving treatment-resistant depression, which includes passing mild electric current through the brain and short-term seizures. By stimulating nerve cells, electric current creates changes in the brain and improves mood.
2- Repetitive Transcranial Magnetic Stimulation (rTMS)
Repetitive transcranial magnetic stimulation or rTMS (rTMS) is the newest and most effective non-invasive treatment for treatment-resistant depression. In this method, by placing a magnetic coil on the scalp, magnetic pulses are sent to certain areas in the brain. These electrical pulses improve treatment-resistant depression by stimulating and regulating nerve cells in certain areas of the brain that affect mood.
3- deep brain stimulation (DBS)
Deep brain stimulation (DBS) is another advanced treatment method for treatment-resistant depression (TRD). In this method, a mild electric current is transferred to a certain part of the brain and stimulates the brain cells in that area.
In the table below, you can see other treatment methods that may be used by mental health professionals:
| Other treatment methods TRD | Description |
| Lithium | Research shows that in some cases, taking lithium in addition to an antidepressant such as citalopram can help improve treatment-resistant depression. |
| pramipexole | This drug is FDA approved for the treatment of Parkinson's disease. However, some studies show that it reduces the symptoms of depression in Parkinson's disease; Therefore, it may help to treat treatment-resistant depression. |
| Monoamine oxidase inhibitors (MAOIss) | MAOIs are prescribed only if other antidepressants fail to improve TRD symptoms due to side effects and precautions.|
| vagal nerve stimulation (VNS) | This method means implanting a device that sends regular and mild electrical pulses through the vagus nerve in the neck to the brain stem. In this way, the levels of specific neurotransmitters in the brain that help regulate mood may be altered, leading to treatment for TRD. |
Is it possible to prevent treatment-resistant depression?
Since the main cause of TRD is not known to researchers, it is not possible to prevent the occurrence of resistant depression. However, mental health experts believe that chronic stress plays an important role in a person suffering from treatment-resistant depression; Therefore, they recommend the following strategies for chronic stress management:
- Exercise regularly.
- Have enough quality sleep.
- Use relaxing methods such as meditation, yoga and deep breathing to calm your mind and body.
- Set goals for your day, week and month to have more control over your tasks and moments.
- Practice mindfulness and gratitude and don't neglect to notice the good parts of your day or life.
- When you are busy and stressed, say "no" to extra tasks and responsibilities.
- Be in touch with people who give you peace, help you with practical tasks and you can get emotional support from them.
- If your stress level is very high during the day and it interferes with your daily activities, be sure to talk to a psychologist.
Guide to see a doctor
Some people with major depression do not respond to common medication and psychotherapy under the supervision of a psychologist. These people, who are suffering from so-called treatment-resistant depression (TRD), have a more complicated treatment path and several strategies should be used to improve them. Fortunately, there are currently several treatment methods such as rTMS for the treatment of TRD, which should be used under the supervision of a neurologist.
In this article from Dr. Keihani's clinic health magazine, we introduced you to the causes, symptoms and treatment methods of treatment-resistant depression. If you have more questions about this, be sure to let us know. You can contact us through Instagram or WhatsApp or contact phones.
