What is Treatment Resistant Depression?
Depression is one of the leading causes of disability worldwide. Up to 6.7% of U.S. adults will suffer from a depressive episode within a given year. There is no single known cause of depression, but medical researchers believe a combination of genetics, temperament, trauma, and biochemical deficiencies may be responsible for causing the disease. While most people can alleviate depression symptoms with medication and therapy alone, almost 30% to 50% of depressed patients will not respond to the usual methods of treatment. In those cases, patients are diagnosed with treatment-resistant depression.
What is treatment-resistant depression?
The majority of depressed patients find relief from either talk therapy, medication, or a combination of the two. But some patients will not respond to these methods. Depressed patients who have tried at least two different antidepressants from two different drug classes and have seen no significant improvement are diagnosed with treatment-resistant depression (TRD).
What are the pharmacological classes of antidepressant drugs?
There is no single cause of depression, but brain chemistry does play a role in symptom manifestation. Depressed patients are often suffering from a lack of crucial neurotransmitters in the brain, most notably serotonin, dopamine, and norepinephrine. In most depression cases, the brain will reabsorb these neurotransmitters too quickly, leading to a decrease in neurotransmitter activity. When this happens, a person will display depression symptoms. Depending on the symptoms and the patient’s unique medical history, a doctor will prescribe any of the following antidepressant drugs:
SSRIs stand for selective serotonin reuptake inhibitors. These drugs are usually the first type of antidepressants a doctor will prescribe because they have the least amount of side effects. SSRIs prevent the brain from reabsorbing serotonin too quickly.
SNRIs are serotonin and norepinephrine reuptake inhibitors. This drug will keep both serotonin and norepinephrine circulating in the brain at optimum levels.
Tricyclic antidepressants are one of the oldest antidepressant drug classes. They affect three, important neurotransmitters – serotonin, norepinephrine, and dopamine.
MAOIs are monoamine oxidase inhibitors. They primarily affect a brain enzyme called monoamine to alleviate depression symptoms. MOAIs are highly effective, but these drugs come with a host of severe side effects and are typically only prescribed as a last resort. Patients who take MAOIs for depression can experience dizziness, trembling, and headaches. MAOIs also have severe interactions with certain foods, medications, and drinks, including fermented foods, and cold and flu medicines. Patients can hallucinate, and experience sudden and dangerous changes in blood pressure.
Antidepressant medications, no matter which drug class they are from, usually take between four and eight weeks to work. During that time, patients may experience an initial worsening of symptoms as the drugs take effect. It is critical that patients start and continue with talk therapy during this time. But if after eight weeks a patient has not experienced a reduction in symptoms or a minimal reduction, a doctor may switch the patient to a different type of antidepressants. If that antidepressant doesn’t work either, a patient may need to try a more rapid-acting treatment protocol.
What are the different rapid-acting treatment methods for depression?
For treatment-resistant depression, patients have several options they can try to find relief from debilitating depression symptoms.
Electro-convulsive therapy is a fast-acting treatment method where doctors induce a seizure episode in the patient with a series of electric shocks. It is a highly effective method for bringing fast relief from depression symptoms. However, it is an invasive procedure that requires rest and may come with side effects such as short-term memory loss.
In VNS therapy, a wire is implanted in the patient’s chest and is connected to the vagus nerve in the neck. The nerve is stimulated with electric signals that travel via the vagus nerve up to the brain to alleviate depression symptoms. VNS is usually a last-resort treatment because it is highly invasive and comes with several risks, including the risk of serious infection.
When it comes to alleviating the symptoms of treatment-resistant depression, TMS is usually the first line of defense. It is non-invasive and does not come with serious side effects that are often present in ECT and VNS therapies.
During a TMS therapy session, a strong magnetic coil is placed over areas of the patients head thought to play a role in depression symptoms. The coil delivers magnetic pulses to these areas of the brain, stimulating the production of critical neurotransmitters. The patient is awake, and they can go to work and drive after a TMS session. The most common side effects of TMS are a mild headache and tingling of the scalp.
Studies on patients with treatment-resistant depression found that TMS is highly effective and cost-effective for alleviating depression symptoms. TMS effectiveness has been studied in adult, geriatric, and pediatric patients with success. Patients who do not have co-morbid anxiety or other mental health conditions see the most improvements with TMS therapy.
When should a patient seek help for treatment-resistant depression?
Depression is a common mental health disorder, and many patients will not find adequate relief with the first type of medication or therapy they try for their symptoms. But with time, persistence, and communication with their medical team, seven in ten patients find a treatment method that works for them. If a patient has tried up to two medications and after six weeks finds no relief from the most debilitating depression symptoms, then they are most likely suffering from TRD.
TMS therapy is the least invasive and most cost-effective of the TRD treatment methods and should be considered before more invasive ECT, and VNS techniques are tried. If you or a loved one have not found relief from depression symptoms with medication, please speak to your doctor about TMS therapy.
The doctors at Pulse TMS have helped hundreds of TRD patients find relief from the debilitating and disruptive symptoms of depression. Please contact the technicians at Pulse TMS today to learn more about how TMS can help you.