The Best Strategies for Dealing with Treatment-Resistant Depression
Introduction
Dealing with treatment-resistant depression can be challenging, especially when traditional antidepressants don’t seem to be providing the relief you seek. However, it’s important not to lose hope, as there are various strategies and approaches that you and your doctor can explore to find a solution that works for you.
Finding the Right Medication
One of the key aspects of managing treatment-resistant depression is finding the right medication that works for your unique situation. As Dr. Jonathan E. Alpert points out, there are more than two dozen safe and effective antidepressants available, but the tricky part is predicting how each individual will respond to them.
- Check Your Medication Usage: Ensure that you are taking your medication as prescribed by your doctor, as skipping doses or stopping medication prematurely can hinder its effectiveness.
- Give It Time: Antidepressants typically take 6 to 8 weeks to reach their maximum effect, so be patient and allow your body to adjust to the medication.
- Adjust Dosage: Your doctor may need to increase or decrease your dosage to find the right balance that works for you.
Exploring Other Treatment Options
If your current medication isn’t providing the desired results, there are several other avenues to explore:
- Switching Antidepressants: Your doctor may suggest trying a different antidepressant to see if it yields better results.
- Combination Therapy: Adding another medication to complement your current antidepressant, such as ketamine, can help enhance your treatment plan.
Pharmacogenetic Testing
For a more personalized approach, pharmacogenetic testing can provide insights into how your body metabolizes medications, helping your doctor tailor your treatment plan accordingly. While these tests won’t determine the best drug for you, they can offer valuable information on dosages and potential side effects.
Key Insights and Recommendations
It’s essential to remember that finding the right treatment for treatment-resistant depression is often a process of trial and error. Dr. Walter Dunn emphasizes the importance of perseverance and communication with your doctor throughout this journey.
Remember that everyone’s experience with depression is unique, and it may take time to find the right medication or combination of medications that work for you. Don’t be discouraged by setbacks, as each step brings you closer to discovering what works best for your mental health.
Summary
Dealing with treatment-resistant depression requires patience, persistence, and open communication with your healthcare provider. By exploring various medication options, adjusting dosages, and considering complementary therapies, you can work towards finding a solution that addresses your specific needs. Remember that each individual responds differently to treatment, so don’t lose hope if the first approach doesn’t yield the desired results. With the right support and a proactive mindset, you can navigate through the challenges of treatment-resistant depression and find a path towards improved mental well-being.
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If you have treatment-resistant depression, you have already tried taking antidepressants without much success. But you shouldn’t give up. It may take time to find the medication, dosage, or combination of medications that works for you.
“There are more than two dozen safe and effective antidepressants,” says Jonathan E. Alpert, MD, PhD, chair of the Research Council of the American Psychiatric Association and professor of psychiatry at Montefiore Medical Center.
The problem is that doctors can’t predict exactly how people will respond to each medication. “Many different factors contribute to depression, such as genetics and life stressors,” says psychiatrist Walter Dunn, MD, PhD, assistant clinical professor of health sciences at UCLA Health. Until the disease is better understood, finding the right treatment will be achieved through trial and error.
Looking for the best approach
You and your doctor can discuss these medication strategies for treatment-resistant depression:
Check that you are taking your medication as prescribed. Three out of four people do not take their medications as recommended by their doctor. Some occasionally skip a day or stop taking a medication when they start to feel better. But these measures can prevent an antidepressant from working well, says James W. Murrough, MD, PhD, director of the Depression and Anxiety Center at the Icahn School of Medicine at Mount Sinai. Talk to your doctor before making changes to the way you take your medications.
Give your current medication more time. Antidepressants usually don’t start working right away. They generally take 6 to 8 weeks to reach their maximum effect, Murrough says. For some people, the process may take even longer.
Your body also needs to adapt to the medication. When you take a new antidepressant, you may have side effects, such as dry mouth, headache, fatigue, or upset stomach. But these symptoms usually disappear after a few weeks.
Change the dose of your medicine. People respond to antidepressants differently. You may need more or less of the medicine than the standard amount. If you don’t feel any different after 2 to 4 weeks, your doctor may increase your dose, Alpert says.
Switch to a different antidepressant. If your medicine is not working, your doctor may suggest that you switch to another medicine. This is common. Research shows that only about a third of people find relief from their depression with the first antidepressant they take.
Most antidepressants affect brain chemicals called neurotransmitters, such as serotonin, norepinephrine, and dopamine. Each type of antidepressant acts on these chemicals differently:
- Selective serotonin reuptake inhibitors (SSRIs). These are usually the first antidepressants prescribed, because they are less likely to cause side effects. They include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro).
- Serotonin and norepinephrine reuptake inhibitors (SNRIs). Duloxetine (Cymbalta), venlafaxine (Effexor XR), levomilnacipran (Fetzima), and desvenlafaxine (Pristiq) are examples of SNRIs.
- Atypical antidepressants. These drugs are not included in the other main categories. Examples include mirtazapine (Remeron), vortioxetine (Trintellix), and bupropion (Wellbutrin SR).
- Tricyclic antidepressants. These older class antidepressants cause more side effects. They include mipramine (Tofranil), nortriptyline (Pamelor), amitriptyline, and doxepin.
- Monoamine oxidase inhibitors (MAOIs). If you take these medications, such as tranylcypromine (Parnate), phenelzine (Nardil), and isocarboxazid (Marplan), you will need to follow a strict diet because they can cause dangerous interactions.
Your doctor may want to try a medication in the same class or a different one. “Research shows that if you don’t respond to one SSRI, another one may work,” Dunn says.
Add another medication to your current antidepressant. Your doctor may want to add another medication to what you are already taking, called an augmentation. “If you feel better and your symptoms have improved by 30% to 50%, we’ll try to add something on top to make up the difference,” Dunn says.
One drug that can be used with an antidepressant is ketamine. Your doctor may suggest it to give you quick relief from treatment-resistant depression. You will take it in low doses intravenously. The FDA has approved a form of nasal spray called esketamine (Spravato). Doctors often recommend that you take an oral antidepressant along with esketamine or ketamine.
Your doctor may also prescribe medications for other problems, such as anti-anxiety medications, antipsychotics, mood stabilizers, and thyroid hormones.
Consider pharmacogenetic testing. With these tests, scientists study a sample of your saliva or blood. They examine your DNA for genes that control certain enzymes or cellular receptors. Most of these tests look at how the body metabolizes or breaks down medications. If you metabolize a medication too quickly, you may need a higher dose of antidepressant, Dunn says. On the other hand, if your body takes longer to metabolize a medication, it can build up and cause side effects.
Pharmacogenetic tests will not show which drugs work best. But they may offer clues about what dosage you may need or your risk of side effects, Alpert says.
Everyone’s depression is different. You may need to try several medications and dosages before you find the right one. One study shows that 67% of people found relief with the fourth medication. The process can be frustrating, but it’s important to keep trying, Dunn says.
“These medications are not permanent,” he says, “so we have the luxury of trying one and then stopping if you don’t like it.” With time, patience, and communication with her doctor, she will likely find the right treatment for her treatment-resistant depression.
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