What is Treatment Resistant Depression?
Frequently I am asked what is treatment resistant depression?
First let’s define depression. Depression in many people’s minds is someone curled up in a fetal position in the dark, crying. But this is not at all the typical presentation of depression. Depression is an illness characterized by some of the following:
Feeling sad or low
Having an "empty" mood
Feeling anxious
Feeling guilty or helpless
Feeling worthless, hopeless, or pessimistic
Feeling restless, frustrated, or irritated
Losing interest in things you once enjoyed
Avoiding your usual activities
Having less energy and feeling fatigued
Moving or speaking slowly
Having difficulty paying attention, remembering, or making decisions
Having difficulty sleeping, waking up too early, or oversleeping
Experiencing unplanned changes in eating habits and weight
Experiencing headaches, cramps, digestive issues, or other aches and pains that don’t have a clear cause and don’t get better with treatment
Talking about death, having thoughts of suicide, or attempting self-harm
Once a Major depression has been diagnosed, if it does not respond to treatment by at least two different antidepressant medications.
In general, the standard for treating depression is to start by treating with a Selective Serotonin Reuptake Inhibitor (SSRI), if a patient does not respond to one of these, the provider will likely trial another type of antidepressant that may target different neurotransmitters in the brain such as epinephrine, dopamine or Gamma-aminobutyric acid which is commonly referred to as “GABA”
If an individual is not responsive to at least 2 traditional antidepressants, there are other options that become available. Recently an inhaled form of Ketamine known as esketamine which goes by the brand name of Spravato, has become available to treat these individuals. Treatment with Spravato has very few limitations on its use. The two biggest limitations from the prescriber side is that the patients’ blood pressure must be less than 140/90, with or without treatment and they cannot have any current or past history or treatment of an aneurysm.
Individuals that are treated with Spravato are given a series of doses of the medication in a monitored setting over the course of 8 weeks. Each treatment episode requires a 2-to-2.5-hour commitment of time to allow for administration of the inhaled medication and monitoring of.
In addition to the use ability to use Spravato, there is also a novel treatment that is available called “TMS” or Transcranial Magnetic Stimulation.
