Advertisements for antidepressant medications might have you believe that simply popping a pill can treat clinical depression. While it’s true that many forms of depression respond well to a combination of medication and therapy, treatment is more complicated for some people.
Those with treatment-resistant depression can still find themselves struggling with symptoms despite these standard approaches.
Also known as treatment-refractory depression, this challenging condition is usually defined as clinical depression that doesn’t respond to at least two different antidepressants. (Some experts define it as depression that doesn’t respond to at least four different antidepressant medications.)
Your symptoms may range from mild to severe, but the key is that typical treatments haven’t worked for you. Estimates vary, but about one-third of people with depression don’t achieve relief from multiple different antidepressants.
If you’ve been diagnosed with treatment-resistant depression, don’t despair: There are several options that may help, including the following.
- First, confirm your diagnosis. Some people who have been told they have treatment-resistant depression actually have another condition, such as bipolar disorder, or have other health issues that can trigger depression, like hypothyroidism, an eating disorder, or addiction.
- Check your meds. Before assuming that a medication isn’t working, make sure you’re taking it properly. Some drugs can take up to 12 weeks to be fully effective, so give it time and speak with your clinician to make sure you’re on an adequate dose. Your doctor may also want to try different medications or different classes of medications, or even add another drug to your regimen.
- Consider other types of therapy. There are several different forms of psychotherapy, and you may respond better to one than to another. If one type of counseling hasn’t helped, talk with your therapist and physician about another approach.
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Sometimes even the tips above won’t help alleviate treatment-resistant depression. In that case, your physician may discuss one of the following options with you.
- Electroconvulsive therapy (ECT). In this procedure, you are given general anesthesia and electric currents (delivered through paddles) are passed through your brain, intentionally triggering a brief seizure. ECT appears to cause changes in brain chemistry through yet unknown ways that can quickly reverse symptoms of certain mental illnesses, like severe depression. It often works when other treatments are unsuccessful and is approved by the Federal Drug Administration (FDA) for treatment-resistant depression. ECT is typically administered two to three times a week for about 10 to 15 treatments, depending on your response and tolerance.
- Transcranial magnetic stimulation (TMS). This is a noninvasive, FDA-approved treatment for depression that uses a magnet placed close to the left front area of your head. This is performed while you are awake and sitting in a comfortable dentist-like chair. Generally, the treatment is well tolerated, but it is not as effective as ECT for many patients. TMS is performed five days a week for four to six weeks.
Find more information on electroconvulsive therapy. To make an appointment, call 412-245-5063.
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UPMC Western Psychiatric Hospital is a nationally recognized leader in mental health clinical care, research, and education. It is one of the nation’s foremost university-based psychiatric care facilities through its integration with the Department of Psychiatry of the University of Pittsburgh School of Medicine. UPMC Western Psychiatric is the hub of UPMC Western Behavioral Health, a network of nearly 60 community-based programs providing specialized mental health and addiction care for children, adolescents, adults, and seniors throughout western Pennsylvania.