Tuesday, November 03, 2009

Guest post on treatment-resistant depression

The following guest post was written by Christine Howell, who writes about online degrees and college-related topics for Online College Guru, an online college directory and comparison website.

If your depression has been treated with medication or psychotherapy, but your symptoms have not improved, you may have treatment-resistant depression. You may still feel sad, hopeless, and disinterested in the world around you. You may have experienced a temporary relief of your symptoms, which then returned. If this happens, then you have treatment-resistant depression and may need to try a wider range of treatments until you find one that works for you. Don’t give up; up to a third of people treated for depression do not respond to the first few rounds of treatment.

What causes Treatment-Resistant Depression?

The underlying causes for treatment-resistant depression are the same as any other form of depression. You just are not responding to treatment. When discussing this condition and treatment options with your doctor, there are several things you should consider.

Have you been taking your medication properly?

The treatment may not be working because you haven’t been administering your medications properly. Check with your doctor on what medications you should be taking, the dosage, and the quantity. Ensure that you are following these instructions precisely. It may take a while before you see results. Do not just assume the medicine is not working and stop taking it. First talk to your doctor; he or she will tell you if it is too soon to make that determination.

Is the diagnosis accurate?

Work with your doctor to confirm the diagnosis of depression. Be very clear about all of the symptoms you have experienced; do not leave anything out. Sometimes there are subtle differences between depression and other mental health disorders, such as mild forms of bipolar disorder, that can result in a wrong diagnosis. Although the symptoms may be similar, the treatments are very different. If the diagnosis is incorrect, you may be receiving the wrong treatment.

Do you have any other health issues?

Some other underlying health problems can mimic depression, or may enhance the depression you are experiencing. Get a thorough physical including blood tests for liver, kidney, and thyroid functioning, and report these results to your mental health care provider.

Who can help you with Treatment-Resistant Depression?

You may have sought initial treatment for your depression from your primary care physician. If the symptoms persist and do not respond to treatment, then you need to see a specialist, like a psychiatrist or mental health counselor—especially if you have tried several medications. Treatments other than medication may help your depression, but these must be administered by an expert.

Do not give up hope; there are many treatment options, and a qualified mental health provider will find the one that works best for you.

Other Treatment Options for Depression

Besides medication and psychotherapy, there are two other treatment options for depression: electroconvulsive therapy and transcranial magnetic stimulation. These are slightly more invasive treatments, but have proven to be very effective.

Electroconvulsive therapy (ECT) is recommended for patients with severe depression who have failed to respond to medication. To receive ECT, a patient is put to sleep with a general anesthesia. Electrodes are placed on the patient's scalp and a trained doctor applies a precisely controlled electrical current, causing a brief brain seizure. The treatment is generally repeated two to three times a week for about four weeks. ECT has proven to be very effective in treating patients with severe depression.

Transcranial magnetic stimulation (TMS) is much more precise and less invasive than ECT. A TMS device creates a magnetic field that induces a very small electric current in a specific part of the brain. The current level is so low that it does not induce a seizure; therefore the patient does not have to be put to sleep for this treatment. TMS is administered as an outpatient service and given about 4 to 5 times a week for several weeks. TMS is most helpful in patients with milder cases of depression who have not responded to an antidepressant.

Christine writes about accredited online degrees and college-related topics for Online College Guru, an online college directory and comparison website. She can be reached at christine.d.howell@gmail.com
Copyright (c) "Ayelet Survivor" and Christine Howell


  1. I knew this was going to be about ECT.

    Isn't there anything better than this after all these years?

  2. Well, there's TMS. There's also changing patterns of diet, exercise, and sleep.

  3. what about addressing the underlying cause of the depression? Do they not do that anymore, just treat the symptoms?

    you know what bothers me about this whole enterprise is that some people are depressed because their lives suck, and psychologists seem to ignore that. Like my friend whose husband is slowly dying from an undiagnosed illness, who has been to countless doctors over the past 10 years, and no one can figure out what is wrong with him- plus she is now drowning in debt because of the hospital costs. You know what? She deserves to be depressed, and I doubt any treatment is going to help her, because what she really needs is money, social support, and a diagnosis and cure for her husband. But psychiatrists just keep giving her more pills and psychologists are just offering ways for her to try to be happier with her situation.

    Who would NOT be depressed in that situation, and why should we as a society enforce this idea that depression is a bad thing that needs to be medicalized or shocked away- I think in many (not all, but many) cases it is a perfectly reasonable response to unreasonable circumstances. Maybe people who are facing unemployment deserve to be depressed. Maybe people who work 90 hours a week deserve to be anxious. Maybe the problem isn't the depression or the anxiety, it's the unemployment and the overwork and the ways in which society is messed up as a whole.

    You know what else bothers me is that if people are medicalizing away all emotion that falls out of a 'normal' range, then why would their be any motivation to change circumstances? I wonder if the rise of anti depressing/anti anxiety meds over the last 20 years has something to do with why more people aren't rising in the streets in our current recession. I expected their to be much more activism and protest, but people seem surprisingly quietly complacent with their circumstances.

    (anyways I particularly dislike psychologist because my dad is one, and spent my whole childhood attributing various mental illnesses to me whenever I disagreed with him- this not an attack on you, more on him). :)

    *steps off soapbox*

  4. AE, feel free to bash psychologists ALL YOU WANT on this blog ;)

    In all seriousness, I agree that this article doesn't go into detail about helping people cope with the real situations in their lives -- that is part of therapy -- and focuses more on other underlying or biological factors.

    But you make an excellent point, and that's why I'm so glad to be a social worker. We look at the person in the context of their environment and consider all relevant factors as potential points of intervention. That includes housing, vocational and educational status, social life and support, etc.

  5. Those "psychologists" that you bash are not the ones dispensing meds. They are among those that use all sorts of versions of psychotherapy to get to the underlying issues. So I am not sure what the continued generalized demonization of psychologists are about.

    Not that there is no room for meds. There is a lot of room for them, and we are fortunate that we live in a day and age where so many are available that help so many people, even save lives, with fewer side effects than ever before. I am so frustrated with the negative generalizations of my field and the psychiatric field. We save lives. We enable people to function where they may not have 50 years ago. We improve the quality of life for millions. Social workers do too. But why idealize social workers and demonize their colleagues?

    AE, Perhaps the psychologist that is "treating" your friend sucks. But the good ones would never have a treatment goal of trying to pretend the reality of someone's situation should have no affect on their mood. I am surprised that a scholar like yourself would make such ill informed statements about an entire profession.

    And as a note, ECT has saved the lives of many people, including three people that have been in my personal life. It is not the same ECT as years ago. It is not painful, it has fewer side effects than meds and it SAVES people from potentially killing themselves. It has a huge success rate for treatment resistant depression.

    Check the research.

    As a psychologist, I do what it takes, and work collaboratively with my colleagues in related professions (psychiatry, social work, guidance counselors, drug and alcohol counselors, etc) to do what I can to help improve the quality of life for my patients. I am not sure why any mental health professional would do otherwise.

    Social work interventions are no panacea. None of our professions alone are. And it is so arrogant to believe that you are the "one" that cures. Unless a person is already so high functioning, it takes a team.

    But my poor social work supervisees who are being mentored by me, a lowly psychologist. They may be sent on some wrong path and cause harm to their patients instead of cure them like a real social worker. Yet somehow they and their patients are not complaining, and are even getting better. But what do any of them know.

  6. AE,
    No one "deserves" to be depressed. And hate to break it to you, but the treatment goal for those who are depressed is not "happiness."

  7. TO, I apologize. After what happened to me in The Bad Place, and with Dr. Incompetent, it's much too easy for me to slip into blanket psychologist-bashing. I forget that many of them, like yourself, are actually competent and caring. I always appreciate your comments.