Major depression affects 10 to 15 percent of the population. Despite advances in the understanding and treatment of depression, only 60 to 70 percent of patients with depression respond to antidepressant therapy. Yet, hope is not lost for such individuals. It takes time to find the best-suited treatment.
“About 40 percent of adolescents with depression do not adequately respond to a first treatment course with an antidepressant medication, and clinicians have no solid guidelines on how to choose subsequent treatments for these patients,” stated Thomas R. Insel, M.D., director of the National Institute on Mental Health. “The results from TORDIA bring us closer to personalizing treatment for teens who have chronic and difficult-to-treat depression.”
Why does it happen?
People develop treatment-resistant depression for numerous reasons:
- Severe depression is hard to treat and may take considerable time
- A co-occurring medical illness and psychological disorders, such as substance abuse or eating disorders, also complicate treatment response
- Family conflicts and anxiety disorders also complicate recovery
Switching up treatment
According to the Treatment of Resistant Depression in Adolescents (TORDIA) study, stretched over 24 weeks, adolescents with treatment-resistant depression can benefit greatly from switching medication or treatment combinations.
The study assessed 334 adolescents, aged 12 to 18 years, with moderate to severe depression, persistent despite treatment with an SSRI for at least 8 weeks.
At the 12th week, 159 responders were able to continue their assigned treatment, whereas the 175 nonresponders were arbitrarily allocated a different medication or therapy for further 12 weeks.
- 6 percent of adolescents responded to treatment, with greater response to a switch in medication plus cognitive behavioral therapy (54.8 percent) than to medication switch alone (40.5 percent).
- There was no significant difference in the response rate between the two medication switch strategies.
- 9 percent achieved cutback by 24 weeks and initial treatment assignment did not affect rates of remission.
- Adolescents who had a clinical response by 12 weeks had three-times greater likelihood of remission at 24 weeks than those who did not.
- 6 percent of those who responded in first 12 weeks relapsed by week 24.
A wide range of treatment options
It’s vital for patients to have sufficient medication for an appropriate amount of time. Most medications treatments last about six weeks, and a partial response to treatment may require up to 12 weeks of use.
If that doesn’t help, then it may be necessary to increase the dose, switching antidepressants, adding another type of antidepressant or medication, and/or getting a cytochrome P450 genotyping test to assess how your body metabolizes medication.
Mental health professionals are trained to help you talk about your fluctuating moods and behaviors. Therapy opens new avenues to handle stress and evade negativity that can set off depressive symptoms.
Psychotherapy for depression includes cognitive behavioral therapy, acceptance and commitment therapy, interpersonal psychotherapy, family or marital therapy and group therapy.
Interacting with depressed individuals may help feelings of loneliness and isolation. There are numerous local support groups for people battling depression.
Electroconvulsive therapy (ECT)
ECT involves placing electrodes on a patient’s scalp, sending a particular current that initiates a controlled short seizure in the brain. ECT is administered with general anesthesia, and the voltage is carefully controlled. While the treatment can have negative side-effects, it also has a large body of evidence to support its efficacy, more than other invasive treatments.
About the author
Sana Ahmed is a journalist and social media savvy content developer with extensive research, print and on-air interview skills, Sana has previously worked as an editor for a business magazine and been an on-air news broadcaster. She writes to share the amazing developments from the mental health world and unsuccessfully attempts to diagnose her friends and family.