What is the definition of treatment-resistant depression?
Feelings of sadness or hopelessness are a normal and natural aspect of life. It occurs to everyone. These emotions may become strong and long-lasting in individuals suffering from depression. This may cause issues at work, home, or school.

Depression is often treated with a mix of antidepressant medication and treatment, including psychotherapy. Some people find that antidepressants are sufficient on their own.

While antidepressants work effectively for many individuals, they do not alleviate symptoms for 10–15 percent of those suffering from depression. Furthermore, 30–40% of Trusted Source report just a partial relief in their symptoms.

Treatment-resistant depression is defined as depression that does not respond to medications. It is also known as treatment-refractory depression by others.

How does treatment-resistant depression become identified?
There are no standard diagnostic criteria for treatment-resistant depression, however physicians often establish this diagnosis if a person has taken at least two different kinds of antidepressant medication and has not seen any improvement.

If you suspect you have treatment-resistant depression, you should see a doctor. While you may be suffering from treatment-resistant depression, they may want to double-check a few factors first, including:

Was your depression diagnosed properly in the first place?
Are there any other illnesses that may be causing or exacerbating your symptoms?
Was the antidepressant administered at the correct dosage?
Was the antidepressant administered correctly?
Was the antidepressant used for a sufficient period of time?
Antidepressants may not act immediately. To observe the full impact, they should be taken in suitable dosages for six to eight weeks. It is critical that the medicines be tried for an extended period of time before concluding that they are ineffective.

However, some evidence suggests that individuals who demonstrate some improvement in their symptoms after a few of weeks of beginning an antidepressant are more likely to ultimately experience a complete recovery.

Those who do not respond to therapy early on are less likely to recover completely, even after many weeks.

What factors contribute to treatment-resistant depression?
There are many hypotheses as to why some individuals do not react to antidepressants, according to experts.

Some of the most well-known are:
Inadequate diagnosis
One of the most widely held beliefs is that individuals who do not react to therapy do not have severe depressive illness. They may exhibit symptoms comparable to depression, but they are really suffering from bipolar illness or another disease with similar symptoms.

Factors of origin
Treatment-resistant depression is most likely caused by one or more hereditary causes.

Certain genetic variants may enhance the rate at which antidepressants are broken down in the body, thus making them less effective. Other genetic variations may influence how the body reacts to antidepressants.

While much more study is required in this area, physicians may now order a genetic test to help decide which antidepressants would work best for you.

Metabolic disease
Another hypothesis is that individuals who do not react to therapy may absorb nutrients differently. According to one research, some individuals who do not react to antidepressant therapy have low folate levels in the fluid surrounding the brain and spinal cord. Nobody knows what causes this low folate level or how it relates to treatment-resistant depression.

Other potential dangers
Certain risk factors for treatment-resistant depression have also been discovered by researchers.

These are some of the risk factors:
The duration of the slump. People who have suffered from severe depression for a longer length of time are more prone to develop treatment-resistant depression.
The severity of the symptoms. People who have either extremely severe or very mild depression symptoms are less likely to react effectively to antidepressants.
Other circumstances. People who have additional disorders, such as anxiety, in addition to depression are more likely to develop antidepressant-resistant depression.

What is the therapy for treatment-resistant depression?
Treatment-resistant depression, despite its name, is treatable. It may just take some time to discover the appropriate strategy.

Antidepressant drugs are the first-line treatment for depression. If you’ve taken antidepressants without success, your doctor will most likely recommend an antidepressant from a different medication class.

A drug class is a collection of medicines that operate in the same manner. Antidepressant medication classifications include the following:

Serotonin-norepinephrine reuptake inhibitors, such as desvenlafaxine (Pristiq), duloxetine (Cymbalta), levomilnacipran (Fetzima), milnacipran (Savella), and venlafaxine (Effexor) norepinephrine and dopamine reuptake inhibitors, such as citalopram (Celexa), escita (Parnate)
If your initial antidepressant was a selective serotonin reuptake inhibitor, your doctor may suggest a different antidepressant in this class or a new antidepressant altogether.

If a single antidepressant does not alleviate your symptoms, your doctor may prescribe two antidepressants to be taken concurrently. For some individuals, the combination may be more effective than taking one drug alone.

Other pharmaceuticals
If an antidepressant alone does not alleviate your symptoms, your doctor may prescribe a different kind of medicine to be taken in addition to it.

Combining additional medicines with an antidepressant may sometimes be more effective than the antidepressant alone. These additional therapies are often referred to as augmentation therapy.

Other medicines frequently used in conjunction with antidepressants include: lithium (Lithobid), antipsychotics such as aripiprazole (Abilify), olanzapine (Zyprexa), or quetiapine (Seroquel), and thyroid hormone.
Your doctor may also advise you to take the following medications:

Ketamine is a dopamine agonist, similar to pramipexole (Mirapex) and ropinirole (Requip).
Nutritional supplements may also be beneficial, particularly if you have a deficit. Some of them may be:

Omega-3 fatty acids or fish oil
Fatty acid folic acid
People who do not respond well to antidepressants may discover that psychotherapy or cognitive behavioral therapy (CBT) is more helpful. However, your doctor would most likely urge you to continue taking your medicine.

Furthermore, some research

According to a reliable source, CBT reduces symptoms in individuals who do not improve after using antidepressants. Again, the majority of these trials include individuals taking medication and engaging in CBT at the same time.

If medicines and treatment don’t appear to be working, there are a few procedures that may.

Two of the most common treatments for treatment-resistant depression are:

Stimulation of the vagus nerve. Vagus nerve stimulation sends a small electrical shock into your body’s neurological system through an implanted device, which may help to alleviate depression symptoms.
Electroconvulsive treatment is a kind of electroconvulsive therapy. This technique, formerly known as electroshock therapy, has been around since the 1930s. It has gone out of popularity in recent decades and remains divisive. However, it may be useful in situations when nothing else works. This is generally reserved as a last option by doctors.
Some individuals attempt a range of alternative therapies for treatment-resistant depression. There hasn’t been much study to support the efficacy of these therapies, but they may be worth a shot in addition to other treatments.

Among them are the following:

brain stimulation at a deep level
treatment using light
TMS stands for transcranial magnetic stimulation.

What about using stimulants?
In recent years, there has been a great deal of interest in utilizing stimulant medicines in conjunction with antidepressants to treat treatment-resistant depression.

Stimulants that are sometimes used in conjunction with antidepressants include:

modafinil is a drug that is used to treat a (Provigil)
methylphenidate is a kind of methylphenidate (Ritalin)
Adderall lisdexamfetamine (Vyvanse)
However, research on the use of stimulants to treat depression has been unconvincing so far.

In one research, for example, combining methylphenidate with antidepressants did not improve overall depression symptoms.

Another research that looked at the use of methylphenidate with antidepressants and another that looked at the use of modafinil with antidepressants found similar findings.

Despite the fact that these trials showed no overall effect, they did indicate modest improvement in symptoms including weariness and tiredness.

Thus, if you experience exhaustion or extreme weariness that does not improve with antidepressants alone, stimulants may be an alternative. They may also be a possibility if you suffer from both attention deficit hyperactivity disorder and depression.

Lisdexamfetamine is one of the most thoroughly researched stimulants used to treat treatment-resistant depression. Although some studies have shown that combining it with antidepressants improves symptoms, other studies have found no effect.

What is the prognosis?
Treatment-resistant depression may be difficult to manage, but it is not impossible. With a little time and effort, you and your doctor can devise a treatment plan that can alleviate your symptoms.

In the meanwhile, try reaching out to others who are dealing with similar issues for advice and information on what has helped for them.

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