3 Approaches for Treatment-Resistant Depression

Selective serotonin reuptake inhibitors (SSRIs) are often the first treatment used for depression. Many people find they have tried different SSRIs on the market without a significant improvement in depressive symptoms. There are other treatment options available when first-line treatments have not worked. How can you address your symptoms if you feel like you've tried everything?

1. Other Classes of Antidepressants

Fortunately, there are many classes of antidepressants that may be more effective than SSRIs. Other classes of medications include reuptake inhibitors that affect dopamine and/or norepinephrine, in addition to serotonin. Sometimes tackling all the neurotransmitters that are associated with mood is more effective than only focusing on one. Some examples of medications that may be helpful include duloxetine, which is a serotonin-norepinephrine reuptake inhibitor (SNRI) or bupropion, which is a norepinephrine-dopamine reuptake inhibitor (NDRI). Other options for antidepressants include tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs). Generally, these classes of antidepressants are reserved for last since the reuptake inhibitors do not require dietary changes like MAOIs and are often better tolerated and safer than TCAs.

2. Possibility of Misdiagnosis

Another consideration with treatment-resistant depression is that your symptoms may have been misdiagnosed. Many people with bipolar disorder were originally misdiagnosed with depression. Bipolar disorder is treated differently since treatment with antidepressants alone may induce manic episodes. Depending on the doctor, they may want to add a mood stabilizer or antipsychotic to your current antidepressant to see if there is symptom improvement. In situations where a misdiagnosis has not occurred, several antipsychotic medications that are used to treat bipolar are also approved to treat depression alone or in combination with an antidepressant.

3. Medical Procedures

Medical procedures are usually reserved for severe, unrelenting depression symptoms that either do not respond to any medication or the person is at risk for suicide. Electroconvulsive therapy (ECT) is the most widely used medical procedure for treatment-resistant depression. The procedure involves using an electrical current while the patient is anesthetized and sedated to create a controlled seizure. Several treatment sessions are needed before patients notice benefits.

A newer medical procedure is transcranial magnetic stimulation (TMS) therapy, which uses a strong magnetic current over areas of the brain that are involved with mood. The procedure is non-invasive and does not require sedation like ECT. TMS therapy is typically done multiple times per week for several weeks before the procedure can reach maximum effectiveness.

When SSRIs are not helpful for depression, you may feel like you will never find relief. Fortunately, there are many options available for people with treatment-resistant depression to live a better quality of life.

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