When a person lives with major depressive disorder (MDD), they tend to get relief from first-line treatments. These include antidepressants and psychotherapy. Common antidepressants fall into the categories of selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). When two or more forms of medications prove ineffective, an individual’s depression is classified as treatment-resistant. Treatment-resistant depression (TRD) is difficult but not impossible to control. Let’s look at the treatment options for TRD.
Medications for TRD
According to a 2020 World Psychiatry meta-analysis of 101 studies, combined therapy and medication were 26% more effective for moderate to severe depression than either option alone. Given the significant improvements by using multiple approaches, a person with TRD is at a disadvantage. Doctors and psychiatrists can use two techniques to treat TRD: combination and augmentation.
Combination includes adding together two antidepressants. Usually, this includes one SSRI and one SNRI. This hits on more pathways and receptors than a single antidepressant.
During augmentation, a typical antidepressant is paired with a medication for another purpose. If done right, the effectiveness of the antidepressant increases because of the second medication. According to Psychiatry (Edgemont), the most common medications for augmentation include:
- Atypical antidepressants
- Benzodiazepines
- Mood stabilizers
- Antipsychotics
- Stimulants
Transcranial Magnetic Stimulation
Another option for TRD is a non-invasive procedure called transcranial magnetic stimulation (TMS). When a person receives TMS, an electromagnetic coil is placed on the scalp over a target area of the brain. Pulses turn on and off, sending electricity through the coil to stimulate neuropathways. This can cause an uncomfortable tapping sensation. The sessions last approximately 40 minutes each, five times a week, for four to six weeks.
Electroconvulsive Therapy
While it was once considered controversial, electroconvulsive therapy (ECT) is now a relatively safe procedure for depression. During ECT, individuals are placed under general anesthesia. Electrical currents flow through electrodes on the scalp to trigger a brief seizure. This occurs around two to three times a week for six to 12 sessions. ECT is mostly used for severe depression or TRD because of the anesthesia, cost, and potential side effects.
When you’ve struggled with depression for a long time, it can feel disheartening not to gain relief. Treatment-resistant depression (TRD) requires more attention and care. You need a care team that can help you arrange various treatment options. At The Guest House, our psychiatry team can help you find the medications for your TRD. Our therapists can offer you independent and group psychotherapy. On top of this, you can engage in less common holistic therapies that could help you feel better. For help, call us at (855) 483-7800 today.