Treatment Resistant Depression

What are the significant factors to consider when encountering treatment-resistant depression?

Often people who undergo treatment for depression are not able to come back to the normal state even after several rounds of treatments. They continue to be in depressed condition and feel miserable and desperate, withdraw themselves from various activities, and perhaps even have thoughts of suicide. It is estimated that about ten to thirty percent of patients taking antidepressants for their depression are in part or completely resistant to the treatment (Joffe et al. 1996). Treatment resistant depression is defined as the persistent symptoms of depression regardless of treatment with a minimum of 3 or 4 diverse medications. There are several factors that need to be considered when encountering treatment-resistant depression (Joffe et al. 1996). This paper discusses in brief some of these factors.

One of the most important factors to be considered is the severity of depression and its duration. For instance, the more severe the depression the longer the episode lasts. Under these circumstances, there are high chances of encountering treatment-resistant depression. Therefore, the therapist needs to know exactly the duration and severity of depression. Another important factor is the wrong diagnosis of depression or other mental illnesses. For instance, the patient with bipolar disorder may be wrongly diagnosed with simple depression, where the mania phase is not diagnosed. It is also essential to take in the genetic aspects while treating the patient with depression.

There are cases when the drug interactions can be a cause of treatment-resistant depression. For instance, if the patient is treated for other health conditions such as thyroid, heart disease, anemia or any other disorders together with the treatment for depression, there can be certain drug interactions that can cause a failure of treatment resulting in treatment-resistant depression. It is also possible that a patient is not following the correct or the prescribed regime while taking the medicines. It is essential to note that the antidepressant drugs need to be taken at specific intervals or else the therapy has a high chance to fail. Additionally any modification of doses by the patient themselves can also have serious resistance problems.

Stress is another factor that can cause resistance to treatment. If a patient is under stress for a prolonged period due to financial or relationship failure or workload, there are chances that they may not respond to the treatment as expected. This is also true if the patient had severe bad experiences of neglect or abuse during childhood. In such conditions it is good to combine psychotherapy together with the treatment with drugs.

It is important that the therapist diagnose the causes of the treatment-resistant depression at the earliest. Tests such as cytochrome P450(CYP450) genotyping test can check the specific genes that affect how the person utilizes the antidepressant drug. Augmentation is another method to enhance the treatment and bring about positive results. For instance the antidepressants together with psychiatric drugs can be given to a patient. In this case the augmentation makes the antidepressant work more effectively (Cadieux, 1998). It is also possible that a patient may respond well to a combination of antidepressants. In some cases by switching over to a different antidepressant drug may help the patient. The therapist needs to select the best approach to encounter treatment-resistant depression. In case the standard medications are not effective it is essential to move on to treatments such as electroconvulsive therapy or Vagus nerve stimulation, Transcranial magnetic stimulation, or even deep brain stimulation (Mayo Clinic Staff, 2007).

References

Cadieux RJ (1998) Practical Management of Treatment-Resistant Depression, Clinical Pharmacology, Web.

Joffe RT, Levitt AJ, Sokolov ST. (1996) Augmentation strategies. J Clin Psychiatry:57(Suppl 7):25-31.

Mayo Clinic Staff, (2007) Treatment-resistant depression: Explore options when depression won’t go away, Web.