Hoping for some relief, people with treatment-resistant depression (i.e., difficult-to-treat depression) have often tried a variety of interventions. For instance, some have tried contemplative practices such as mindfulness meditation; some, deep brain stimulation and similar neurostimulation treatments; others, psychedelics like psilocybin (magic mushrooms).
But do these interventions work? And what does the latest research say about safe and effective ways of managing the symptoms of severe depression?
Published in the October 2023 issue of World Psychiatry, a recent paper by R. S. McIntyre and collaborators discusses the diagnosis and evidence-based management of treatment-resistant depression.
What follows is a summary of the article.
According to the Food and Drug Administration (FDA), treatment-resistant depression requires failure to respond to two or more antidepressants.
But many other definitions have also been proposed. Most of these differ in the following ways:
Over 100 million people around the world meet the criteria for treatment-resistant depression, according to at least one of the definitions.
Treatment-resistant depression is costly, not only for individuals but also for society. It is associated with greater impairment in functioning, physical illnesses (e.g., heart disease, diabetes, obesity), work absenteeism, need for disability benefits, health care utilization, carer burden, and the frequency and intensity of interventions required to manage it.
Risk factors for treatment-resistant depression include the following.
So, what works in managing difficult-to-treat depression?
According to the available evidence, the following 10 strategies may be worth pursuing.
Potential problems associated with interventions for difficult-to-treat depression include the following.
To manage depression that has not responded to only one previous antidepressant, useful strategies include a trial of second-generation antipsychotics, rTMS, and adjunctive psychotherapy.
To manage depression that has not responded to multiple antidepressants, the authors recommend esketamine nasal spray, IV ketamine, adjunctive psychological therapies, ECT, and rTMS.
Meanwhile, many other therapies are under investigation. Some examples are S-adenosylmethionine, anti-inflammatory agents (e.g., COX-2 inhibitors, statins), buspirone, dextromethorphan-bupropion combination, lithium, L-methylfolate, thyroid hormone, and zuranolone.
Significant research has focused on psychedelics such as psilocybin—and for good reason, given the promising preliminary findings.
In short, numerous effective treatment options are available and many new ones are being studied.
If you have treatment-resistant depression, talk to your doctor about the advantages and disadvantages of different interventions, including the best antidepressant for you.
In the meantime, you can make healthy lifestyle changes that may improve both your physical and mental well-being. So, try to get sufficient sleep, exercise regularly, eat healthy, and use stress-reduction techniques (e.g., deep breathing, yoga, meditation, relaxation training).
To find a therapist, please visit the Psychology Today Therapy Directory.
10 Science-Based Solutions for Difficult-to-Treat Depression
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31.12.2023
Hoping for some relief, people with treatment-resistant depression (i.e., difficult-to-treat depression) have often tried a variety of interventions. For instance, some have tried contemplative practices such as mindfulness meditation; some, deep brain stimulation and similar neurostimulation treatments; others, psychedelics like psilocybin (magic mushrooms).
But do these interventions work? And what does the latest research say about safe and effective ways of managing the symptoms of severe depression?
Published in the October 2023 issue of World Psychiatry, a recent paper by R. S. McIntyre and collaborators discusses the diagnosis and evidence-based management of treatment-resistant depression.
What follows is a summary of the article.
According to the Food and Drug Administration........
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