Treatment-Resistant Depression: Signs, Symptoms, and Solutions for Brooklyn Residents

Key Takeaways:

• For some patients, depression doesn't respond to traditional therapy or medications
• Treatment-resistant depression can be debilitating, but there are new treatments coming our every year that promise relief
• Ketamine therapy and esketamine nasal spray both show great promise in relieving symptoms of treatment-resistant depression in some patients

As part of Brooklyn's vibrant community, we consider it our job to watch out for the mental health of our people.

Depression is one of the most common mental health conditions in the world, and can vary from mild to severe. Characterized by fatigue, hopelessness, and a lack of enjoyment of previously fun and interesting activities, depression has a massive impact on the lives of those who have it.

As such, mental health professionals like us take it upon themselves to dedicate time and resources not only to improving the symptoms of individual patients with therapy and medication, but also to pool knowledge and academic research into finding or developing the best treatments available.

But there is another, more rare form of depression: treatment-resistant depression.

Let's learn more about this debilitating (but not hopeless) form of depression, and explore options for those who have it.

Treatment-Resistant Depression Resources on This Page:

What is treatment-resistant depression?

Alternative Treatments for Treatment-Resistant Depression

What is treatment-resistant depression?

Treatment-resistant depression refers to cases of depression that are just not responding to the usual course of treatment attempts.

If you have tried:

• Several antidepressants

• Several types of therapy

• Several lifestyle changes

and still feel symptoms just as strongly, there is a good chance you have treatment resistant depression.

Luckily, there are a few alternative treatment methods you can try, as well as new FDA-approved innovations in ketamine therapy that show great promise.

Don't give up.

What causes treatment-resistant depression?

While they are often lumped into the same group, there are actually two ways that treatment-resistant depression can occur: internally and externally.

Treatment-Resistant Depression Due To Internal Factors

Just like some people have a genetic predisposition to depression, some people have a genetic resistance to medication. This can often cause treatment resistant depression.

It's also possible to have a case of depression that is so severe and chronic that traditional medications and therapies simply aren't strong enough.

For these people, alternative treatments and new innovations like Spravato (esketamine) can be a promising way to make progress.

Finally, existing health conditions like cancer and thyroid problems can make depression worse.

Treatment-Resistant Depression Due To External Factors

Externally caused treatment-resistant depression can happen in many ways, but a few of the most common are:

• Medical mistakes - Doctors are highly-trained experts, but they're still human. The symptoms of depression can actually be caused a number of physical conditions, which can lead to a misdiagnosis of depression. Obviously, taking an SSRI won's help your depression symptoms if they are being caused by a vitamin deficiency.

• Improper use of medications - A very common cause of treatment-resistant depression, improper use of medication can prevent symptom improvement and even make them worse. Be sure to always take your medication exactly as prescribed. There is a scientific reason for every detail of a prescription, including dose size and timing.

• Conflating lifestyle problems - Regular depression can become treatment resistant if your lifestyle choices remain poor. Continuing to drink heavily while taking anti depressants can be deadly, but it also prevents the antidepressant from working properly.

Typically, doctors and psychiatrists try to rule out any external factors for your treatment-resistant depression.

Often, this means taking a blood test to ensure vitamin levels and other blood factors are within healthy ranges. A medical professional may also recommend lifestyle changes and ensure you are taking medication properly.

If all of the external factors for your treatment-resistant depression are ruled out, then your doctor or psychiatrist may refer to one of the alternative treatments described below.

How do I know if I have treatment-resistant depression?

If you are otherwise healthy and:

• Have no deficiencies of any nutrients

• Have tried several different antidepressant medications and evidence-based therapies

• Still feel symptoms

You may have treatment-resistant depression.

Alternative Treatments for Treatment-Resistant Depression

Medical science is always evolving, and mental health developments are no exception. Below are some of the most well-known methods to treat treatment-resistant depression.

Spravato Nasal Spray (Esketamine)

Spravato is the brand name for a new form of treatment for those with major depressive disorder and treatment-resistant depression.

The active ingredient of Spravato is esketamine, so named because it's the "S" or left-handed enantiomer of ketamine.

Note that R-ketamine, the more famous version of the molecule, is often referred to simply as ketamine. Ketamine is only FDA-approved as an anesthetic, and is used largely by veteranarians and sometimes by human doctors.

Some doctors use ketamine off-label to treat depression. It must be administed intravenously, making it an inconvenient process.

Spravato, by contrast, can be suspended in an inert fluid and administered via a nasal spray, making it far more convenient and often cheaper.

During a Spravato treatment, you will be monitored by a doctor for two hours after taking it, in order to keep you safe and ensure that there are no adverse effects.

Often, a psychiatrist will partner with a therapist in order to provide talk therapy alongside Spravato treatment.

You will also be given an oral anidepressant during your course of Spravato sessions.

Electroconvulsive Therapy

Electroconvulsive therapy is a procedure where a doctor passes an electrical current through your brain that makes you go into a seizure.

It sounds grisly, but those electrical currents are very small and precisely measured by the most sophisticated equipment available.

You'll also be under general anesthesia (a.k.a. fast, fast asleep) when the seizure occurs.

Interestingly, no one knows the exact chemical process that occurs during this procedure. What we do know is that it can be an effective treatment for those with treatment-resistant depression. Seizures cause all sorts of chemical processes in your brain. Apparently, one of them helps with depression.

Repetitive Transcranial Magnetic Stimulation (rTMS)

During rTMS, a doctor will use an electromagnet to conduct an electric field within the part of your brain that gets "depressed" or inhibited when you have depression. The process is thought to stimulate chemical and neuronal activity in that region, reducing symptoms of depression.

Treatment Resistant Depression Program in Brooklyn: Williamsburg Psychiatry Group

Williamsburg Psychiatry Group, the psychiatric arm of Williamsburg Therapy Group, staffs some of the best psychiatrists in New York. With our top notch medication management, our partnership with the best therapists in the city, and Spravato treatment newly on offer, we're ready to help our fellow Brooklyn residents fight treatment-resistant depression.

Give us a call today to discuss your options for treatment.