Medications for Treatment-Resistant Depression continued...
While not truly a drug, Deplin -- a prescription medicinal food that contains folate -- is also used to enhance the effect of an antidepressant.
Where will your doctor start? It really depends on the person. Here are some of the things that your doctor will consider when deciding what drug treatment to try next.
What drugs haven't worked? If you have treatment-resistant depression, your doctor is unlikely to suggest that you go back on a medicine that didn't help. In fact, he or she might suggest shifting to a different class of medication, which might work in a completely different way in the brain.
What drugs have helped a bit, but not enough? If a particular medication has helped ease your treatment-resistant depression symptoms at least a little, your doctor might suggest that you stick with it. Then to boost the effect, you could add on a second antidepressant or a different kind of drug.
If any close relatives had depression, what medication worked for them? There might be a genetic component to how well a person responds to a medication.So something that worked for your father or sister might be more likely for work for you.
What are the side effects? Your doctor will consider how the possible side effects might affect you specifically to get a good match. For instance, some antidepressants can increase the risk of weight gain. For some, that might be unacceptable or even dangerous. But for others -- like people who have lost weight during a depression -- it could actually be a good idea.
Of course, one of the things your doctor might need to do is get you off some of the medications you're on now. If you've been struggling with treatment-resistant depression for a long time, you might have accumulated a lot of different prescriptions over the years. Some of those drugs might not have any purpose. Others might be interacting with each other, or even worsening your symptoms.
When you're trying a new drug for treatment-resistant depression, make sure to give it a fair chance. Cook says that many people who think they are treatment-resistant -- because they've tried a number of antidepressants without success -- might not be. Instead, they just weren't on the medicine long enough to know one way or another. Side effects are often the reason.
"One of the drawbacks to virtually all of the antidepressants is that the benefits come late and the side effects come immediately," Cook tells WebMD. However, he says that if you can stick with a medication for a couple of weeks, those side effects often resolve themselves.
Psychotherapy for Treatment-Resistant Depression
Along with medications, talk therapy -- like cognitive-behavioral, psychodynamic, and interpersonal therapy -- is one of the first approaches that a person with treatment-resistant depression might try.