How to Cope: Dealing with Treatment Resistant Depression

Treatment resistant depression is diagnosed when an individual's depression doesn't respond to treatment with two different antidepressant medications after being given adequate dosing and enough time to work. If both tries at using antidepressants are unsuccessful, and individual may be diagnosed with treatment resistant depression. There are other ways to cope with this type of depression, including psychotherapies, different types of medications and other alternative therapies.

What Causes Treatment Resistant Depression?

A study by Roger J. Cadieux, M.D., from Pennsylvania State University of Medicine that was published in American Family Physician, showed that between 10% and 30% of patients diagnosed with depression were resistant to treatment with antidepressants alone.

According to the Mayo Clinic, treatment resistant depression has its basis in a combination of genetic and environmental factors that include stress, health problems, other mental health issues and not taking medications as prescribed. There is also the chance that a different type of medication that alleviates symptoms of depression may need to be tried as each individual reacts differently to each type of medical treatment.

Environmental Triggers and Alternative Therapies

Emotional stress is an environmental trigger to depression. If the situation causing stress isn't changed or the stress dealt with, medication alone may never be enough, no matter how many different antidepressants are tried. Sometimes alternative therapies that reduce stress, such as psychotherapies, hydrotherapy and music therapy, can be used instead of or in addition to the use of antidepressants as treatment for depressive symptoms induced by stress.

Psychotherapies such as cognitive therapy and behavioral therapy can help the individual to learn life coping skills to deal with situations to make better decisions and to reduce stress. Hydrotherapy, or water therapy, has a relaxing effect and can help promote sleep which is necessary to help reduce symptoms of depression. Music therapy has been shown to be relaxing and to promote positive thinking that can help to reduce stress and symptoms of depression.

Medical Triggers, Conditions and Solutions

Certain other health problems or even substance abuse can increase depression. For example, diseases such as fibromyalgia that cause chronic pain can lead to depression. Living with chronic pain increases stress, may prevent an individual from performing enjoyable activities and can reduce sleep, all of which can make depression worse. A physician should check for underlying medical causes before diagnosing treatment resistant depression. Many substances that are abused have depressant effects and should be avoided, especially if you are dealing with treatment resistant depression.

Many symptoms for mental illness can overlap. If the individual is being treated for depression but has a different disorder, antidepressants may not be effective. Certain types of bipolar disorder, anxiety, post-traumatic stress disorder and other mental health conditions can carry depression as a symptom of the larger illness. In these cases, attempting to treat the symptom of depression may be ineffective until the actual condition is treated properly.

If an individual is diagnosed with depression, it is important to take all medications exactly as prescribed by the doctor. When medications are skipped, reduced or not taken as prescribed, depressive symptoms won't be alleviated and may even become worse. If a condition or other medications are affecting depression, talk to your doctor about treatment of the condition or changing medication.

Medications for Treatment Resistant Depression

There are many types of medication that can be effective in dealing with hard-to-treat depression. The first medication approved for this was Symbyax, according to a press release by Lilly, the makers of this combination medication.

Symbyax is a combination drug of the antidepressant fluoxetine and the antipsychotic drug olanzapine. This combination can be used for depressive episodes of bipolar disorder and depression that has been resistant to the use of antidepressants alone.

There are several types of antidepressants, including SSRIs, SNRIs, MAOIs and tricyclic antidepressants. Each has its benefits and risks. One type may work where another has failed as each individual's depression may respond differently to different pharmacological treatments.

First-Hand Experience with Treatment Resistant Depression Due to Misdiagnosis of Mental Illness

I had what was believed to be treatment resistant depression. I was put on Prozac, with the dose being increased to 80 milligrams. For reference, the average dose of Prozac to effectively treat depression is 20 milligrams. The high level of antidepressant actually triggered episodes of hypomania, showing an underlying and previously undetected bipolar disorder.

After several bipolar diagnoses, my most recent diagnosis is rapid-cycling Bipolar II. A decrease in the Prozac, with the addition of Abilify to stabilize moods helps to keep my depression (and hypomania) in check.

If antidepressants in one category do not alleviate symptoms, another type of antidepressant or a combination of medication and alternative therapies may be most beneficial to those whose depression appears resistant to treatment.

SOURCES:

Roger J. Cadieux, M.D., Practical Management of Treatment-Resistant Depression, http://www.aafp.org/afp/981200ap/cadieux.html

Mayo Clinic, Treatment-resistant depression, http://www.mayoclinic.com/health/treatment-resistant-depression/DN00016

Lilly; Symbyax; http://files.shareholder.com/downloads/LLY/1268919441x0x281748/86a45323-7196-46b8-a5d3-c12bcc10c318/LLY_News_2009_3_23_Product.pdf