Treatment-Resistant Depression symptoms may look like depression; depression and anxiety combined, or sometimes even like the up-and-down mood swings associated with bipolar disorder. Treatment-Resistant Depression (TRD) is a relatively common occurrence.
Here are some basic facts about TRD:
- 50% to 60% of patients with a history of bipolar, anxiety-based or major depression have not achieved an adequate response following antidepressant treatment.
- Approximately 50% of patients diagnosed with major depressive disorder will experience a recurrent or chronic course of illness for which long-term treatment is recommended.
- At least 20% of patients diagnosed with depression do not respond satisfactorily to several traditional antidepressant medication treatment trials
Treatment-resistant depression may be the result of the following issues:
- The patient resists taking medication as prescribed: This represents 40% of patients and may be due to a lack of understanding or education about the process, low self-esteem, or other mental health issues.
- The medication dosing has been too low: Also known as sub-therapeutic depression, this is the cause for 20% of patients.
- The patient experienced intolerable adverse effects: This means the patient can not/will not tolerate negative side effects of antidepressant medications and is the cause for 20-30% of patients.
- The patient received the wrong diagnosis: The symptoms may be arising for another reason entirely, such as thyroid disease, nutritional deficiencies, sleep apnea, latent bipolarity, co-occurring mental illnesses like ADHD or addiction. This is the case for 10-15% of patients.
What’s the next step for managing treatment-resistant depression in such cases?
One of the first questions I ask clients with TRD is whether their psychiatrist has mentioned repetitive transcranial magnetic stimulation — also known as rTMS or simply TMS — and if so, if they’ve determined whether they are good candidates.
Repetitive transcranial magnetic stimulation is an evidence-based neuromodulation technique that gets added to a patient’s current medication regimen, and which modifies neurotransmitters in the limbic region of the brain. It is noninvasive, meaning it does not involve any type of surgery or surgical process, and therefore also does not involve either sedation or hospitalization.
The technique works by generating magnetic pulses that penetrate brain tissue and induce electrical currents that can correct imbalances in neuron activity, often leading to improvements in symptoms that have otherwise been hanging on.
TMS therapy has been proven to be safe and effective in many world-wide clinical studies and is currently being tested for treating several other mental health and medical conditions. It’s exciting science for sure!
After a period of 4-10 weeks of receiving treatments, many people’s brain chemistry will reach some range of normalization. This means they can now proceed with other types of therapy mentioned above, as well as with other strategies and holistic life changes.
Here are seven holistic strategies that help sustain wellness and brain chemical balance if you suffer from treatment-resistant depression.
1. Exercise on a regular basis
Regular exercise increases the production of endorphins. It’s the feel-good brain chemical that can lift mood, plus improve sleep quality, energy level, and concentration.
2. Practice yoga
Yoga is an Eastern-influenced practice that’s thousands of years old. It involves the mind, body, and spirit, using slow, purposeful positions and movements while also focusing attention on the rhythm of your breathing.
3. Make good food choices
Nutrition has a direct biochemical reaction on our system. Harvard Health confirms that a rich, plant-based diet influences mood stability; and decreases risk of depression happening or worsening. Ever had a blood sugar drop because you waited too long for lunch? Drowned your date disappointment in too many bobas with cookies? Notice your mood then.
4. Try mindfulness exercises and techniques
Mindfulness is an ancient tradition like yoga. It trains you to remain focused on the present moment; instead of ruminating about the past, anticipating future events, and, thereby keeping emotional angst enlivened.
5. Get regular massages
Massage therapy helps to release serotonin and dopamine while reducing cortisol levels. This improves mood and reduces depression and anxiety symptoms.
6. Participate in your favourite hobbies
Participating in hobbies or interests that inspire you or excite your passions raise your mood, while also boosting self-confidence and self-esteem.
7. Listen to — and make — music
Music is an imperative tool to use. It feeds the right side of the brain, which is where our emotions live. It can also offset the negative impact of too much screen time on this part of the brain.
Using music regularly activates your brain in positive ways, both when you listen, and even more so, when you make it. You don’t need to riff like Brittany Howard or sing with perfect pitch. Pick pieces that you happily, passionately enjoy.