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Medications for Treatment-Resistant Depression

Treatment-resistant depression (TRD) gets its name because the usual medications do not work for these depressives. Taking any of the usual antidepressants such as tricyclics or selective serotonin inhibitors (SSRIs) can make them feel even worse. Other medications are available, but TRD treatment does not solely rely on medication. It also uses counseling.

  1. Time Frame

    • It takes a while for antidepressant medications to work in a person. For some people, this adaptation phase is longer than others. According to the Mayo Clinic, any medication used for TRD or any other kind of depression can take up to two months before a person will feel any benefits. However, a doctor should be contacted immediately if suicidal thoughts develop.

    Symbyax

    • In March, 2009, the U.S. Food and Drug Administration approved a new medication with the brand name Symbyax for treatment-resistant depression. This is a combination of two SSRI antidepressants, fluoxetine HCL, better known as Prozac, and olanzapine, brand name Zyprexa). According to the manufacturers, Eli Lilly & Co., this medication is only for patients who have already tried at least two other types of antidepressants.

    Switching

    • The Mayo Clinic reports that one in three people diagnosed with depression do not feel any benefits with the first antidepressant the patient tries. The National Mental Health Alliance (NAMI) reports that this also happens to 40 percent of teenagers and adolescents with depression. Both the Mayo Clinic and NAMI recommend switching to another antidepressant and, if that fails, to switch to yet another medication. This switching has to be done under the supervision of a medical professional, or the patient may suffer painful withdrawal symptoms. There may be a break of about two weeks in between medications to be sure the previous medication is completely out of the patient's body.

    Supplements

    • The Mayo Clinic also reports that a nutritional supplement derived from folic acid given in large doses has helped some people with TRD. The supplement is called L-methylfolate (brand name Deplin). The theory is that taking L-methylfolate helps the brain's neurotransmitter receptors function more normally. However, this needs to be taken under a doctor's supervision in order to avoid overdosing, birth defects or bad interactions with other drugs.

    Diagnosis

    • The Mayo Clinic also reports that some people with TRD have a gene that makes them physically unable to process SSRIs. There is a test called the cytochrome P450 (CYP450) genotyping test that can determine if that is the problem. This can make finding effective medication quicker by ruling out the entire SSRI class of drugs.

    Counselling

    • Medication can help a patient to be more open to trying suggestions brought in cognitive-behavior therapy sessions. In this type of psychological counseling, patients learn to interpret the world around them more accurately. They also learn to recognize if their thinking is due to accurate information or due to symptoms of their depression. Counseling also helps when a patient is in between medications.

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