Refractory Depression Description

Refractory depression is also known as treatment-resistant depression; both are psychiatry terms used to describe cases of major depression that do not respond to the use of at least two antidepressants. It has been reported that many who suffer from depressive disorders do not experience the full effects of antidepressant treatment. That being said, most patients eventually feel the full effects of their treatment, even though the time it took their bodies to respond was significantly delayed.

Significance

• Many who experience depression have great success with a combination of medications or prolonged use of one medication in particular. Those who experience refractory depression, however, have been forced to seek out other options for their disorder. Some methods, such as combining different kinds of drugs, have been proven to work. A combination of an SSRI and a TCA drug may help, as studies have shown that 50 percent of patients who fail to respond to desipramine or a similar TCA will respond to an SSRI, and vice versa. Much of the treatment also depends on the level of refractory depression and if the response to the medication is partial or non-partial.

Effects

• Those who do not respond to existing depression therapies, such as medication and psychotherapy, can experience even worse depression that leaves them feeling helpless. This type of depression can become debilitating, which is why seeking out other treatments becomes so necessary, even if it's more extreme.

  Some people who do not benefit from more traditional treatments often undergo electroconvulsive therapy, which is more commonly known as electroshock therapy. This type of therapy is well-established, yet still controversial. It involves electronically inducing seizures in anesthetized patients for therapeutic effect. This form of therapy is only used in refractory depression, mania, bipolar disorder, catatonia and schizophrenia.

Considerations

• It has recently come to light that utilizing medications more commonly used for different brain disorders can be very helpful in cases of refractory depression. If you or someone you know is suffering from refractory depression, consider discussing with your doctor the use of seizure medication for the treatment of mood disorders and borderline personality disorders.

Misconceptions

• Many misconceptions and stigmas are attached to using electroshock therapy (ECT). Though it's true that it may not be right for everyone suffering from refractory depression, it has been proven to work. ECT is usually considered as a treatment of last resort, though it is widely considered the most powerful tool available to treat depression. That being said, it's not used very often, but this is more likely due to misconceptions and stigma about ECT than to its effects.

Prevention/Solution

• Aside from the traditional medications, electroshock therapy, and use of non-standard medications already discussed, new technologies such as transcranial magnetic stimulation are being studied as a safer alternative to ECT. Other new treatments for refractory depression also include more invasive interventions, such as nerve stimulation. Anti-psychotics have also shown great promise in treating treatment-resistant depression, but unfortunately these medications often come with serious side effects.