Treatment-Resistant Depression


ST. LOUIS, Mo. (Ivanhoe Newswire) — In the United States alone, over 16 million adults have experienced at least one major depressive episode in the past year. Of these individuals, around 30 percent do not respond to standard treatments such as medication or therapy. This means that approximately 4.8 million people are dealing with treatment-resistant depression, a condition that can significantly impact their quality of life. Now, researchers are finding new ways to give these patients hope at living a happier, more fulfilling life.

Creating colorful artwork helps 69-year-old Christy Hart control some pretty dark thoughts that she’s struggled with for most of her life.

Christy says, “I can remember my senior year of high school being extremely depressed.”

At 40, the depression again became overwhelming.

“I got Prozac and it was like somebody took a paper bag off my head and the world existed outside.” Explains Christy.

Then in her 60’s, health issues, combined with the pandemic, sent her spiraling again.

Christy says, “I didn’t take pleasure in much anymore.”

Already taking the antidepressant Effexor, Christy found out about a groundbreaking study at Washington University School of Medicine.

“The worst news about it is we usually don’t know in advance that someone’s depression is gonna be treatment-resistant. We still, in this day and age, use a trial-and-error approach.” (:11)

Psychiatrist, Eric Lenze found that adding the anti-psychotic medication – aripiprazole — can help.

Doctor Lenze explains, “The underlying idea is if you take two antidepressants from different classes, you may have a higher chance of getting better from depression.”

Doctor Lenze says 30 percent of the treatment-resistant patients finally found relief.

Christy says, “It was a pretty remarkable change really quickly.”

Christy now uses another drug called Bupropion along with Effexor, and says it’s changed her life.

“Being happy is a nice thing, you know, more energy, less sleeping. People don’t realize what depression does until you start to get help.” Says Christy.

She definitely agrees with doctor Lenze.

“Just because it’s been called treatment-resistant doesn’t mean give up hope.” Explains Doctor Lenze.

The problem is particularly difficult in older adults, many of whom already are taking several medications for other conditions such as high blood pressure, cardiac issues, or diabetes. Switching to new antidepressants or adding other psychiatric drugs can be complicated. But because depression and anxiety in older adults may accelerate cognitive decline, there’s an urgency to find more effective treatment strategies. Mental health professionals recommend seeking help as soon as possible if you or someone you know is struggling with depression and exploring a range of treatment options to find what works best for them. Another option is the use of intravenous ketamine off label which a recent study led by a Harvard doctor found to be a promising alternative to electroconvulsive therapy.

Contributors to this news report include: Marsha Lewis, Producer; Roque Correa, Editor.



REPORT #3085

BACKGROUND: Treatment-resistant depression (TRD) happens when at least two different antidepressants don’t improve symptoms. The two treatments must be of adequate dosage and duration (at least six to eight weeks) before a diagnosis can be given. First-line antidepressants for the treatment of major-depressive disorder (MDD) are usually SSRIs (selective serotonin reuptake inhibitors) or SNRIs (serotonin and norepinephrine reuptake inhibitors) because they generally have fewer and less severe side effects compared to other antidepressants. Approximately 30 percent of people who’ve been diagnosed with MDD and tried medications have TRD. MDD is one of the most common mental health conditions and affects five percent to 17 percent of people at some point in their lives.


PREVENTION FOR TRD:  Scientists are not exactly sure of the cause of TRD, so it’s generally unpreventable. However, chronic stress has been known to play a role. There are some steps that can help manage stress such as exercising regularly, as even a short walk can boost your mood. Getting quality sleep is essential to overall health and help keep stress levels down. Relaxation activities like meditation, yoga, breathing exercises, and muscle relaxation help with stress. Setting goals for the day, week, month will help you feel more in control of the moment and long-term tasks. Practicing mindfulness, gratitude, and acknowledging the good parts of your day or life can help keep you more relaxed as well as staying connected with people who keep you calm, provide emotional support, and help you with practical things.


ADVANCES IN RESEARCH AND TECHNOLOGY FOR TRD: Advances in research and technology have created new Food and Drug Administration-approved treatment options for TRD symptom relief. Some of the breakthrough treatments being offered are transcranial magnetic stimulation which stimulates the brain in targeted areas to decrease chronic depression symptoms. With a response rate close to 60 percent, it resynchronizes and resets the brain. Another treatment option is esketamine. This is a nasal spray that treats depression in conjunction with oral antidepressants, helping them to work better. Treatment is approved for adults with TRD or MDD with suicidal ideation or behavior. Electroconvulsive therapy (ECT) is the most effective treatment for severe depression. ECT improves depressive symptoms by causing changes in brain chemistry and neural connections. Performed under general anesthesia, small electric currents are passed through the brain to achieve the most benefit with the fewest risks There is also an off label use of intravenous ketamine that was just studied by a Harvard doctor and sponsored by the Cleveland Clinic Foundation.

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