When people suffering from depression are treated with antidepressants for more than six weeks without improvement, they may be diagnosed with treatment-resistant depression.
In such cases, they could feel better than before but still face problems such as having a hard time at work because they can’t think very well. They may also have a lot of anxiety or experience crying episodes. This clearly means that they are still suffering from depression that has only been partially cured.
Why would it not get better?
Studies show that about 40% to 60% of cases of treatment-resistant depression can be related to bipolar disorder. That’s a pretty high percentage. So, this is something for you and your doctor to ponder over as a possible reason if you’re not getting better with antidepressants.
The other thing your doctor should look at is possible medical issues interfering with treatment for depression. Common medical issues that can make it harder for depression to resolve completely are hypothyroidism, chronic pain, low testosterone, inflammatory illnesses, and sleep apnea.
Atypical antipsychotic medications such as Risperdal and Zyprexa are some of the most studied treatment-resistant depression drugs known to be useful. A major problem with these drugs is that they are associated with excessive weight gain.
While newer ones like Abilify and Rexulti cause significantly less weight gain, they cause a condition called akathisia which is basically clinical restlessness.
In short, most medical options have certain side effects that can be mild to extremely severe. However, newer alternatives such as spravato, are known to have relatively insignificant and temporary side effects such as dissociation, dizziness, sedation, etc. While you can take it orally, it also comes in a few other forms, such as the spravato nasal spray.
Alternative Non-medical options.
So what if you can’t take any of these medicines because of side effects, or they aren’t working for you? You can seek the two most common non-medication options, which are electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS).
ECT works by stimulating a seizure under general anesthesia. Although that may sound extreme, it works very well and can be useful for people who can’t take medications. However, the biggest drawback of ECT is the memory problems that come with it. Since this treatment uses anesthesia to stimulate the brain, many patients have mentioned having trouble remembering things before and after the treatment.
Some people also say that they just don’t feel as sharp as they used to. TMS was developed to overcome this issue of memory loss. It stimulates the brain using technology that’s similar to an MRI. However, It doesn’t work as well as ECT, and you need a lot more sessions. Usually, five days a week for six weeks, making it a big-time commitment.
These alternative and additional treatments are only necessary only if the concerned person is truly treatment-resistant. For instance, if you don’t feel better despite your doctor putting you on 25 milligrams of Zoloft for two months, that’s not a failed trial of medication. The first step would be to increase to a minimum of 50, probably followed by 100 milligrams, and then make a decision depending upon the results.
However, you may notice a tiny improvement with 50 milligrams, which may imply increasing your dose for better effectiveness. Further, if you notice problems such as reduced sex drive or insomnia, it means your body cannot handle increased doses without the side effects. This is when it’s better to look for non-medical options as discussed above or consider trying newer solutions like spravato.