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 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.
Other Treatments for Treatment-Resistant Depression
Drugs aren't the only approach used in treatment-resistant depression. Some other methods included in the treatment of treatment-resistant depression are:
Talk therapy. Approaches like cognitive behavioral therapy – which focuses on concrete goals and how your own thoughts and behaviors contribute to your depression -- can really help people with depression. There’s some evidence it works well with treatment-resistant depression specifically.
One study looked at people who didn’t respond to an antidepressant. The researchers found that cognitive behavioral therapy led to a 50% improvement in symptoms – just as effective as trying another regimen of medicines. Although the evidence is limited, other approaches – like interpersonal or psychodynamic therapy – might also help.
If you've tried therapy in the past and it hasn't helped, you could try again. Think about seeing a new therapist. Or look into a different therapeutic approach. For instance, if one-on-one therapy didn't do much for you, you could give group therapy a try.
ECT (electroconvulsive therapy.) ECT is typically used in people with serious or life-threatening depression that can’t be resolved by other treatments. It uses electric impulses to trigger controlled seizures in the brain. This treatment can rapidly relieve depression, although it's not clear how long the effects last.
VNS (vagus nerve stimulation.) This approach is also used in people with serious depression that just hasn't responded to other treatments. Like ECT, it uses electrical stimulation to relieve the symptoms of depression. The difference is that the device is surgically implanted in your body. The evidence that VNS helps with treatment-resistant depression is unclear.
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.
- Experimental techniques. Experts are researching new techniques to tackle treatment-resistant depression, like deep brain stimulation and MST (magnetic seizure therapy.) Although some studies have been promising, more research needs to be done. But if you're interested in trying them, talk to your doctor about joining a clinical trial.
Sometimes, a doctor might recommend hospitalization for treatment-resistant depression. It could be the best option if your depression is severe and you're at risk of hurting yourself. A stay in the hospital also offers a way for you to recover from your depression in a safe and stable environment. You’ll get a break from some of the daily stresses that might contribute to your condition. Your doctors will also get a chance to collaborate and come up with a good treatment plan.