Treatment-Resistant Depression: Getting Help continued...
Treatment-resistant depression can be hard to diagnose. Sometimes, other conditions or problems can cause similar symptoms. So when you meet with your doctor, he or she will want to:
- Confirm the diagnosis. Some people who apparently have treatment-resistant depression were misdiagnosed. They never had only depression in the first place. Instead, they have conditions like bipolar disorder (where antidepressants may be less effective than in unipolar depression), or problems with drugs or alcohol that can cause depression, or a medical condition (such as hypothyroidism) that can cause symptoms of depression, and may have been getting the wrong treatment. Other people have dysthymia – a low-level, chronic depression – that is distinct from treatment-resistant depression.
- Make sure you've been using your medicine correctly. Up to half of all people who get prescribed drugs for depression don't take them as recommended. They miss doses or stop taking them because of side effects. Some give up too soon – it can take 4-12 weeks for a medicine to take effect.
- Check for other causes. Other issues – ranging from thyroid problems to substance abuse – can worsen or cause depression. So can many medicines used to treat common medical problems. Sometimes, switching medicines or treating an underlying condition can resolve a hard-to-treat depression.
You may wonder why some people do so well with the first medication they try, while you continue to suffer. Experts don't really know. But evidence suggests that people who have especially severe depression may also be harder to treat. A long duration of symptoms may also increase the risk – which is one reason it's so crucial to get control of depression symptoms quickly. The longer depression goes on, the harder it may be to control.
Medications for Treatment-Resistant Depression
If your current medicine isn't helping – or isn't helping enough – other drugs might. There are two basic approaches:
- Switching medicines. If one medicine doesn't work, your doctor will probably recommend trying another instead.
There are a number of different classes of antidepressants, including SSRIs (like Brintellix, Celexa, Lexapro, Paxil, Prozac, and Zoloft) and SNRIs (like Cymbalta, Effexor, Khedezla, Fetzima, and Pristiq). Older classes of antidepressants include tricyclics (like Adapin, Aventyl, Elavil, Pamelor, and Tofranil ); tetracyclics (like Asendin, Ludiomil, Mazanor, and Remeron); dopaminergics (like Wellbutrin) and MAO inhibitors (like Emsam, Marplan, Parnate, and Nardil). These different types of antidepressants have different effects on the brain chemistry. Sometimes, switching from one class of antidepressant to another can make a difference.
Another option is to switch from one drug to another in the same class. A person who wasn't helped by one SSRI could still benefit from a different one.
- Adding a medicine. In other cases, your doctor might try adding a new medicine to the antidepressant you're already using. This can be especially helpful if your current drug is helping, but not completely relieving your symptoms.
What medicines might he or she try? One option is to add a second antidepressant from a different class. This is called combination therapy.Another approach is called augmentation therapy: adding a medicine not typically used to treat depression, like lithium, an anticonvulsant, or an antipsychotic. Abilify and Seroquel are FDA approved as add-on therapies to an antidepressant for treatment-resistant depression. Symbyax is a combination drug that contains the active ingredients in Zyprexa and Prozac together in one tablet and is approved for the acute treatment of treatment-resistant depression. One drawback to this approach is that the more medicines you take, the greater potential for side effects.
People have different reactions to the drugs used for treatment-resistant depression. The medicine that works best for one person might have no benefit for you. And unfortunately, it's hard for your doctor to know beforehand what drug or combination of drugs will work best. Arriving at the right treatment can take patience.