Treatment for Major Resistant Depression

Depression is the number one mental health problem in American today. The National Institute of Mental Health estimate that it affects 6.8 million Americans every year and is the number one cause of disability among people ages 15 to 44. A major depressive episode can cause the sufferer to feel hopeless, worthless and unmotivated. Further, it puts individuals at greatly increased risk for suicide. While most patients with depression experience a decrease in symptoms when they are involved in a comprehensive treatment plan, individuals with resistant depression may have a far more difficult time finding treatments that work for them.

Definition of Resistant Depression

• The Mayo Clinic defines resistant depression as "the continuation of depression symptoms despite treatment with at least three or four different medications." There are many different reasons that a depressive episode can be resistant to treatment, including noncompliance with prescription medications, unusually severe depression, underlying medical issues and stressful or traumatic life events. Resistant depression is different from dysthymia, which is a low-grade, mild depression that can last a long time but does not cause severe symptoms.

Treatment Compliance

• First and foremost, the patient must take prescribed antidepressant medications exactly as directed. The Mayo Clinic points out that one of the primary reasons that patients do not have success with their depression treatment is because they do not consistently take their medication. Patients should discuss side effects or other concerns about their prescriptions with their doctor. Discontinuing antidepressant medications suddenly can cause serious withdrawal symptoms.

Switching Medications

• Because different people react to medication in different ways, one of the first approaches that most doctors take in treating resistant depression is to try a new medication. Research conducted by the National Institutes of Mental Health has found that only one in three people with depression get adequate symptom relief from the first antidepressant medication that they try. Yet, of those who go on to try other medications, the majority will be successful with the second, third or fourth try.

Psychotherapy

• The Mayo Clinic notes that psychotherapy has proven very effective in helping to alleviate symptoms of resistant depression, particularly when it is used in conjunction with medication. If a patient with resistant depression is already in psychotherapy and is not getting sufficient symptom relief, there are other options for treatment. For example, changing therapists or the mode of therapy may help. Behavioral cognitive therapy, which focuses on practical application of methods to improve mood and change behaviors, can be helpful.

Electroconvulsive Therapy

• Despite the stigma that often accompanies the idea of ECT (electroconvulsive therapy), it remains one of the most effective means of treating resistant depression when other attempts have failed. ECT involves sending a controlled electrical current through the brain to induce a seizure. This seizure alters brain chemistry, often providing immediate relief of depressive symptoms. ECT is performed while the patient is under anesthesia.