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Treatment-Resistant Depression: Your Continuum of Care

Psychotherapy for Treatment-Resistant Depression continued...

Research has shown that therapy can help with treatment-resistant depression specifically. The best evidence is with cognitive-behavioral therapy (CBT), which encourages people to see how their own thoughts and behaviors contribute to their depression. One study looked at people who didn't get better using an antidepressant. Researchers found that switching to CBT improved symptoms by 50%. Talk therapy took longer to have an effect, but in the long run was just as effective as trying a different medication.

MacKinnon believes that the concrete focus of cognitive-behavioral therapy can be especially helpful for people struggling with treatment-resistant depression. Approaches that delve into your past and deeper emotional issues might not work as well right now, he says.

"When you're in the middle of a depression, it's really hard to look back at your life and learn from it," MacKinnon says. "Your depression will so distort your perspective that you might come up with the wrong lessons." It might be more productive to engage in that sort of therapy once the depression has lifted, he says.

However, the best therapeutic approach for treatment-resistant depression really depends on what feels right. Keep in mind that many therapists use a combination of approaches. Perhaps the most important thing is to find a therapist whom you like and trust. Having a good partnership is likely to boost your chances of success.

Brain Stimulation for Treatment-Resistant Depression

There's another very different approach to tackling treatment-resistant depression: electrical stimulation of the brain. Doctors have long known that using electrical impulses can sometimes relieve the symptoms of depression.

Some of these approaches have been around for decades, such as ECT, which was once called electroshock therapy. Others are cutting-edge and only in clinical trials now. Here's a rundown of the various approaches for treatment-resistant depression.

ECT (electroconvulsive therapy). ECT uses electrical impulses to trigger a controlled seizure in the brain. It's generally reserved for severe or life-threatening cases of depression where nothing else has helped. But it works well and takes effect much faster than medication.

If you're considering ECT, Cook advises that you go to a specialty center if possible. ECT can result in memory loss and confusion, which may take a few weeks or months to clear up. You might get better results with health care professionals who do the procedure regularly.  

TMS (transcranial magnetic stimulation). This approach was approved by the FDA in 2008 for treatment-resistant depression in people with severe depression. Using an electromagnet, your doctor sends bursts of energy to specific parts of the brain.

TMS has some advantages over other electrical stimulation treatments. It's done on an outpatient basis -- usually four to five sessions a week for four weeks. You could get it right in the doctor's office; the doctor just holds a small device against your scalp. It's painless, doesn't require surgery, and has few side effects and risks. Some insurance plans will cover TMS treatments if a person is diagnosed with severe major depressive disorder, and Medicare programs in some eastern and southern states recently began covering the therapy.

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