Psychiatry has made a good deal of headway in recent decades in the treatment of depression.For some patients, however, even the most tried and true psychiatric interventions can generate few results. These patients, oftentimes, have what is known as “treatment-resistant” depression. This form of depression may affect as many as 1 in 3 patients with depression.While frustrating, there are new interventions that can help these patients, including the administration of innovative new medications, such as Spravato.
Determining if a Patient’s Depression is Treatment-Resistant
As a first step, a psychiatrist must first determine whether or not a patient’s depression is, in fact, treatment resistant. To do this, most psychiatrists ask that a patient first adhere to traditional treatment protocols and interventions for a given amount of time. There is no standard diagnostic criteria for identifying treatment-resistant depression; as such, patient experiences may vary from case to case.Generally, psychiatrists want to see that a patient experiences no or few benefits after trying at least two different types of antidepressants.Co-morbid conditions can also make treating depression more complex. For this reason, a psychiatrist may wish to determine whether or not the patient has any other conditions that may be compounding their depression. These can include but are not limited to drug and alcohol abuse, sleep disorders, anxiety disorders, eating disorders, and medical comorbidities such as hypothyroidism.
Treating Treatment-Resistant Depression
Once a psychiatrist has established that a patient’s depression is resistant to treatment, they will start developing an alternative treatment plan for that patient. A treatment plan for treatment-resistant depression can involve a multi-pronged approach that combines multiple interventions, including:
- Switching medications
- Somatic therapies
- Psychotherapy
Switching Medications
A primary line of treatment for treatment-resistant depression involves switching a patient’s medications. A psychiatrist may recommend adding a second medication, sometimes called an augmentation agent. One medication that has proven successful for many patients with this condition is Spravato, an esketamine nasal spray. By prescribing Spravato in tandem with oral anti-depressants, a doctor can help patients who have previously had little success in overcoming depression experience relief.Spravato is self-administered by the patient in a clinical setting under a doctor’s supervision. This is to help manage some of the short-term side effects that can come with this medication. The outcomes for Spravato are positive: Randomized trials have shown that Spravato can have efficacy rates as high as 40 to 60 percent in patients with treatment-resistant depression.
Somatic Therapies
In addition to medications, some psychiatrists employ somatic therapies in treating this condition. These interventions include transcranial magnetic stimulation and electroconvulsive therapy, which stimulate nerve cells in the brain related to depression and induce chemical changes in the brain respectively.
Psychotherapy
As with most psychiatric conditions, psychotherapy is often at the heart of treating treatment-resistant depression. There are many forms of psychotherapy, the efficacy of which can depend on the patient and their own unique needs. A patient can consult with their psychiatrist to determine what form of psychotherapy is best suited for them in addressing treatment-resistant depression.
Ask Your Psychiatrist About Their Approach
Treatment-resistant depression doesn’t have to go untreated. There are options out there. By working in close consultation with a medical professional, patients with this frustrating form of depression can experience relief. To begin exploring your own options, reach out to the professionals at one of our centers to see how they can help you start to overcome your treatment-resistant depression.
