Depression is a mental state in which the patient suffers from mood disorders with a continued feeling of sadness, anxiety, loss of interest and other behavior related as well as emotional problems. This causes loss of focus and the patient is unable to attend even to the routine activities. Depression can be cured with or without treatment depending on the severity and symptoms.

In cases when, the treatments do not prove fruitful in treating the depression then such a condition is called treatment resistant depression or treatment refractory depression or TRD. The patients suffering from treatment resistant depression or treatment refractory depression fail to respond to the treatments whether be counselling or medications. In general, a combination of psychological counselling and antidepressants are prescribed which gives positive results; however, in case of treatment resistant depression patients or treatment refractory depression patients, these standard treatments prove insufficient and the symptoms keep coming back.

Treatment Resistant Depression or Treatment Refractory Depression

Treatment Resistant Depression or Treatment Refractory Depression: An Overview

Treatment resistant depression is also called as treatment refractory depression which can be defined as a case of major depression disorder in which the patient does not respond positively to the appropriate trials of at least two types of antidepressants doses over a given duration. This condition is a common occurrence during the clinical trials in which around 50% to 60% of the patients show responses ranging from partial response to total resistance towards the treatment.

When to visit a Mental Health Professional?

The patients should look out for certain signs and symptoms of depression which require medical attention. These include:

  • Continuous feeling of sadness
  • Persistence of anxiety
  • Feeling of emptiness
  • Mood swings
  • Constant feeling of hopelessness
  • Pessimistic attitude with feelings of guilt and worthlessness
  • Feeling helpless
  • Loss of focus
  • Loss of sex drive
  • Changes in appetite followed by weight loss or weight gain
  • Irritated behavior
  • Restlessness
  • Fatigue
  • Insomnia.

Risk Factors for Treatment Resistant Depression or Treatment Refractory Depression

The factors that can pose as a risk for the treatment resistant depression or treatment refractory depression are:-

  • Phases or circumstances of life that the patient may find unable to cope with and may suffer from depression.
  • Inability to respond well to treatments like medications, psychotherapy etc.
  • Certain non-prescription drugs and herbal supplements can contribute to presence and continuity of depression.
  • Irregularity in administering the prescribed medication and treatments.
  • Presence mental disorders other than depression like bipolar disorder, dysthymia, personality disorder that may require a different treatment and reduce the effects of existing treatments.
  • Presence of other physical health conditions like thyroid, heart problems and other chronic conditions that may worsen the depression and prevent the effective treatment.

Prevalence of Treatment Resistant Depression or Treatment Refractory Depression

According to different studies, around 35 million individuals suffer from major depression in the United States. Among these, over 45% individuals fail to respond to the antidepressant treatment of appropriate dosage and duration. Around, 15% show resistance towards multiple depression treatments. The prevalence of treatment resistant depression or treatment refractory depression is dependent on the longevity of the depression because, longer the patient remains depressed, lesser shall be the chances for recovery.

Treatment for Treatment Resistant Depression or Treatment Refractory Depression

When antidepressants fail to treat depression, then the related medical supervisors can switch to alternative treatments. Such treatments include:

  • Taking Medication for Extended Time Period for Treating Treatment Resistant Depression or Treatment Refractory Depression: In common scenarios, the course of medication for effective treatment is around 4 to 8 weeks. However, for some individuals suffering from treatment resistant depression the medication dosage may be required for an extended duration, so that it can effect to the fullest. It usually happens when the patient develops some side effects and then some time is required for the side effects to subside.
  • Increased Dosage of Prescribed Medication: Response to a medication is different for each individual, which means that some patients suffering from treatment resistant depression or treatment refractory depression may require a higher dose than the prescribed dosage for effective treatment. However, this should be done only under medical supervision otherwise it may prove to be harmful.
  • Shift to Other Antidepressants: If the prescribed antidepressants do not work even when the duration or dosage is increased then the medical advisor can switch to alternatives of existing medication to cure treatment resistant depression or treatment refractory depression.
  • Switching to Another Type of Antidepressant: The medical supervisor can change the medication to another class of antidepressants after assessing the behavior and mood related problems of the patient. These medications target behavior related neurotransmitters like serotonin, dopamine and norepinephrine.
  • Following the Augmentation Technique: When the patient suffers from depression as well as other mental or physical disorders, then a combination of existing medication along with disorder related medication is required. This approach is called augmentation in which antidepressants are prescribed along with anxiety medications, thyroid medication, beta blockers, mood stabilizers and other drugs.
  • CYP450 Genotyping Test: The genes associated with the metabolizing and processing of medication have a varied effect on the synthesis of P450 enzymes depending on each individual. This test helps in identification of the type of medication that can successfully work on an individual suffering from treatment resistant depression or treatment refractory depression.

Counseling for Treatment Resistant Depression or Treatment Refractory Depression

The counseling for treatment resistant depression patient or treatment refractory depression patient helps in identification of the underlying issues within the patient and helps them to deal with the same by building the required confidence and positive attitude. The general approach followed is opting psychological counseling or psychotherapy to address the underlying concerns that may cause the depression. These work great along with the medications and help in speedy recovery. Psychotherapy helps in dealing with emotional trauma, challenges encountered in life, stressful relationships and much more. This helps an individual suffering from treatment resistant depression or treatment refractory depression to have a happy and a healthy start to a new life with a fresh outlook.

Other Treatment Option for Treatment Resistant Depression or Treatment Refractory Depression

When neither the medication nor the psychological counseling helps in treatment of depression, then additional treatments are required to deal with treatment resistant depression or treatment refractory depression. These treatments include:

  • Electroconvulsive Therapy (ECT) for Treatment Resistant Depression or Treatment Refractory Depression: This therapy is used to reverse the symptoms for depression by altering the chemistry of the brain through passage of mild electric currents.
  • Transcranial Magnetic Stimulation (TMS) for Treating Treatment Resistant Depression or Treatment Refractory Depression: TMS utilizes magnetic fields to treat depression and mood swings by stimulating the nerve cells in the brain. This is done by placing a large electromagnetic coil against the forehead which creates electric currents to stimulate nerve cells in the brain.
  • Vagus Nerve Stimulation (VNS) for Treating Treatment Resistant Depression or Treatment Refractory Depression: Vagus nerve is the nerve that runs through the neck to the region of the brain and controls the moods and behavior of an individual. In the VNS therapy, a device is implanted in the chest which is connected by a wire to the vagus nerve in the neck. This device sends electrical signals via vagus nerve to the brain, which in turn helps in treating depression symptoms.

Lifestyle and Coping with Treatment Resistant Depression or Treatment Refractory Depression

The key to effective treatment of the treatment resistant depression is the positive approach and a fresh perspective of the patient towards life. There are also certain tips that can be followed to cope with the existing condition. These include:

  • Strictly following the Treatment Plan: It should be ensured that the patient must complete the entire course of the treatment and no sessions or medicines should be skipped. If skipped it may lead to coming back or sustenance of the symptoms. In case, there are any side-effects to the existing medications, immediately contact the doctor to check for alternatives.
  • Lifestyle and Behavior Modifications: To treat the depression, a fresh approach and a better lifestyle is a necessity. Some do’s and don’ts that can be followed are:
    • Avoid alcohol, smoking and drugs: Depression may result in increased consumption of alcohol and drugs or increased smoking habits. These can lower chances of effective treatment and hence must be avoided in all circumstances.
    • Stress Management: A calm and peaceful mind is a must in order to fight depression which can be achieved by meditation, yoga and other mind relaxing techniques.
    • Proper Sleep Routine: Irregular sleep can result in fatigue, irritability, stress and mood swings. Therefore, it should be ensured that proper sleep and rest should be taken.
    • Regular Exercise Routine: Exercise is known to ease and de-stress the mind as well as the body. It also helps in getting proper sleep. Hence, regular exercising can help in relieving depression to a great extent.

Treatment resistant depression or treatment refractory depression could be very difficult to manage as the psychiatrist needs to keep changing the medicines to check which one suits the individual and provides the necessary relief. One needs to have a lot of patience when suffering from treatment resistant or treatment refractory depression. Maintaining a healthy lifestyle, proper sleep and food habits, avoiding smoking, drinking and drugs are some of the most essential things to be taken care of when dealing with treatment refractory depression. A good family support is also of utmost importance as often the person feels irritated and needs more support; they can also think of self-harming techniques due to frustration of not getting relief from their condition. This needs to be carefully checked both by the treating doctor and also the family member and friends. Although, it might take a little time but when the advices of the treating doctor are followed whole-heartedly, relief is bound to be achieved.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: July 5, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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