Treatment Resistant Depression

18-24 April 2016 is Depression Awareness Week

Depression can be very effectively treated with talking therapies and medication, given time for them to work, but during this Depression Awareness Week it is worth looking at the times when this does not happen.

Treatment resistant depression (TRD) is not uncommon and affects a considerable number of patients who come for treatment for depression.  Typically, TRD is diagnosed if a patient has tried two or more types of antidepressants without success. However, in practice, it is harder to identify.

It is important to ensure that, before a diagnosis of TRD is made, a patient has given their antidepressant enough time to work.  Many patients stop taking their medication or do not take it consistently enough for it to have an effect, making it look like it is not the right medication for them.

It is normal for a new antidepressant to take at least six weeks, and sometimes as long as twelve weeks, to work.  General health, including exercise, sleep and eating habits, can influence the effectiveness of the anti-depressant and the use of augmenting agents such as lithium can also be investigated.  There is considerable evidence that supports the use of talking therapies such as Cognitive Behavioural Therapy (CBT) in conjunction with medication.  This provides many options and variations for a consultant to use before determining a patient has TRD and therefore looking for alternative treatments.

Electroconvulsive Therapy (ECT), Transcranial Magnetic Stimulation (rTMS) and Vagus Nerve Stimulation (VNS) have all been used effectively when combinations of medication and therapies have been exhausted.  Each one uses a different method to directly affect the brain through the use of electric currents.

It can be very difficult to find the right treatment or combination of treatments for patients with TRD, however, a good consultant will work with you to pursue every option available and help you manage your depression during that search.

Consultant psychiatrist Prof Anthony Hale has a special interest in the diagnosis and treatment of treatment resistant depression and offers appointments in Kent and SE London. If you or a loved one are suffering from TRD, please get in touch to make an appointment.

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