Treatment Resistant Depression

When you’ve tried standard depression meds but they do not work, you may have Treatment Resistant Depression (TRD). Definitions vary but it means that you have tried 2 to 6 medications with no luck. Fortunately, there are more options for you.

New Medications

In 2019, the FDA approved two new medications that are very different from the standard depression meds. One is brexanolone, which is meant for post-partum depression.

The other is esketamine. This is a drug that has been around for decades as an anesthetic. It has even been used as an anesthetic for animals. Doctors discovered that in low doses, it relieves depression with great success. At first it was only given intravenously. But now, it is available as a nasal spray. You still have to use it in a hospital or doctors office for now. I have heard wonderful things about it.

Other Treatments

ECT (electroconvulsive therapy.) ECT uses electric impulses to trigger controlled seizures in the brain. A series of ECT treatments (usually 6-12 over a few weeks) can often rapidly relieve depression, although some form of continued therapy (either a medicine or else periodic ECT “booster” treatments are usually necessary to prevent relapse.

VNS (vagus nerve stimulation.) Like ECT, this uses electrical stimulation to relieve the symptoms of depression. The difference is that the device is surgically implanted in your body. VNS is FDA-approved for the long-term (not acute) depression of chronic depression that does not respond to at least two antidepressant trials. Its effects may take up to 9 months to appear and studies have shown that a meaningful response seems to occur only in about 1 in 3 people. That doesn’t sound great.

TMS (transcranial magnetic stimulation.) This is a non-invasive approach that’s been approved for treatment-resistant depression. Like VNS and ECT, it uses electrical stimulation to treat depression. Unlike those procedures, TMS poses few side effects. It may be best for seriously depressed people who are mildly resistant to drug therapy. Treatment is done on an outpatient basis four to five days a week for four or more weeks. It is considered safe, but appears to be not as effective as ECT.

There are other experimental treatments out there. Ask your doctor.

I have bipolar II. I feel depressed at times, even though I take meds. I usually ask myself, is this sadness/emptiness/boredom due to a specific reason? Like a romantic breakup or trouble at work? Because it’s normal to feel down when the situation merits it. If I don’t have a reason, and it comes out of nowhere, I’ll call my doctor.

One thing that helped me is that in addition to my Lexapro, we added Abilify which is an anti-psychotic. But in a low dose it acts as a booster to an antidepressant.

Therapy is probably as effective as meds for most people. The problems are finding a good therapist, the cost, dealing with insurance, etc. Also, therapy takes work. It can be very emotional. And time consuming. I’ve been in and out of therapy for over 20 years. I always found that time was my biggest obstacle. So I started therapy with a wonderful woman on See more about this under “Helpful Resources” in my main menu.

If you suffer from depression, don’t give up until you get the help you need. Hugs, ❤️😀💥🙏

4 thoughts on “Treatment Resistant Depression

  1. I agree, therapy is very effective for some (and I was one of the lucky ones). but others need medication to reduce their symptoms before going into therapy. Unfortunately, as we know, ‘once size doesn’t fit all’ in mental health. We just have to keep trying until we find what works for us. Interesting to see you’ve mentioned Transcranial Magnetic Stimulation (TMS) cos, proud mummy moment, my eldest son has been researching TMS for depression for some years and has written many papers. There’s still more research needed to arrive at a positive conclusion.


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