Depression is a mental health diagnosis. As a clinical condition, depression can impact almost every aspect of daily life, from social engagement and personal relationships to self-care motivation. In severe cases of depression, even maintaining a job can be challenging.
People living with depression never know when their symptoms are going to start or finish. One of the common misunderstandings is that depression is persistent daily. While the diagnosis never goes away, there may be times when the symptoms are manageable. And when someone with depression feels productive, energetic, and happy.
Depression is thought to be caused by a chemical imbalance. A combination of lifestyle and hereditary factors can also contribute to pronounced symptoms. For many people, depression can be treated successfully with a variety of medication and counseling therapies.
For a small percentage of Americans, however, the debilitating symptoms of depression do not go away. They persist, even after years of talk therapy and a variety of different psychotropic medications. People with treatment-resistant depression can go years and even decades with unresolved symptoms. At which time, clinical depression evolves into a permanent disability. And patients often feel like there is no hope in sight to help them live a normal life.
How is Treatment-Resistant Depression Different?
Physicians and psychologists use mood scales, like the Beck Depression Inventory, to test whether a patient has depression. The scale asks about daily mood, energy levels, appetite, and other lifestyle and social habits. And it assigns a score. With the Beck Depression Inventory, a higher score indicates significant symptoms of depression.
Treating depression happens in accelerating steps. First, medications are prescribed to see if symptoms can be resolved or partially resolved with prescriptions. The next step is to add beneficial counseling or talk-therapy. This allows the patient to discuss stressors in their life. The third therapeutic step is often cognitive-behavioral therapy or CBT. This helps the patient learn to manage their symptoms better and improve self-care.
Through each one of the treatment steps for depression, medications may be changed. When all the steps or treatment options have been exhausted, a diagnosis of Major Depressive Disorder (MDD) is common. Bipolar Disorder is another common misdiagnosis for what is now called Treatment-Resistant Depression (TRD).
There are two main features of treatment-resistant depression that differentiate the diagnosis from other mental health disorders. First, the symptoms do not resolve, even after years of different clinical treatments and approaches. Second, there is a strong correlation between treatment-resistant depression and suicidal ideation. Patients with TRD have a statistically higher rate of self-harm.
Treatment-resistant depression has been something of a clinical finish line. And patients feel like they have run out of options, and no one else can help.
What Causes Treatment-Resistant Depression (TRD)?
Did you know that there is no officially recognized definition of treatment-resistant depression? Globally, there is no list of criteria that differentiate TRD from other types of depression diagnoses. And that is proof that the medical community has a lot of work to do to understand the condition. And provide better treatment options.
Some clinical studies have suggested that TRD is a chronic and lifelong condition that cannot be treated. That the chemical and emotional triggers that cause treatment-resistant depression lie deep within the human brain. In areas that do not respond to conventional therapies. One clinical study estimates that as many as 60% of patients with depression may have TRD.
Modern medicine does not know what causes TRD. But what they do know is that patients share common traits, experiences, and lifestyle habits. Some of these symptomatic traits include:
- Long durations of depressive symptoms that create atrophy in some regions of the brain responsible for regulating mood and energy.
- People with long-term chronic pain or thyroid disorders may be at a higher risk.
- Chronic insomnia may be a factor.
- Substance abuse and eating disorders may be contributing causes.
One of the reasons why medication therapy does not work for people with TRD is that the problem may be occurring in non-conventional places in the brain. Standard depression responds to medications that trigger serotonin and norepinephrine (happiness hormones). Antidepressants may not work for patients with TRD if other unknown chemical reactions cause it.
Risk of Self-Harm Higher for Patients with Treatment-Resistant Depression
Life with the most severe symptoms of major depressive disorder can be unbearable. What keeps patients going is hoping that they find some physician who has a new idea or therapy. Something that could help the individual return to normality.
People who have treatment-resistant depression have a higher risk of suicidal ideation. That means the symptoms are so disruptive, and they feel so hopeless that ending their life seems like the only option. Some patients feel like physicians “give up” on them and make them feel like no treatment will ever work. And that the symptoms will never go away.
There are five main treatment strategies for patients with TRD. They are optimization, switching, combination, augmentation, and somatic therapies. And psychiatrists (not primary care providers) can develop a personalized treatment plan for patients.
One of the new and exciting frontiers of alternative medicine is the use of psilocybin treatments. Patients with post-traumatic stress disorder in the United States have shown improvement with ongoing treatments. And it offers a new ray of hope for Americans living with TRD.
What is Involved in a Psilocybin Treatment?
Some alternative health clinics in the United States offer ketamine treatments for patients with PTSD and MDD (major depressive disorder). Ketamine is also a psychedelic drug that causes hallucinations. Psychedelics can help unlock deeply rooted trauma and make psychological therapies more effective.
If Psilocybin treatments are approved, they would likely follow the same protocols as ketamine clinics in the United States are currently using. The patient would sit in a comfortable chair in a private and relaxing room. The psychedelic would then be administered as a needle, a capsule (pill), or a dissolving oral strip.
The patient is left alone but monitored and supervised for safety. When the microdose’s psychedelic effects have worn off, patients often receive a talk-therapy session with a psychiatrist. Ketamine (unlike psilocybin) is permitted for off-label use in the United States.
Can Psilocybin Treatments Work?
The use of psychedelics in healthcare is not new—historical evidence of many cultures used ‘magic mushrooms’ to achieve a state of enlightenment. To unlock the brain, creativity, and existential thoughts is part of the psychedelic ‘trip.’ And now, western medicine is taking a look at the potential to use it to penetrate treatment-resistant depression and provide relief.
Oregon was the first state to legalize Psilocybin. On Tuesday, November 3rd, voters in Oregon decided to legalize and decriminalize Psilocybin. Unlike some prescription medications, psilocybin is not naturally addictive. And periodic clinical treatments may be safer (and more effective) than drugs.
Psilocybin is classified as a Schedule 1 drug and federally prohibited. One day after Oregon announced the legalization of psilocybin for mental health treatments; Johns Hopkins University released an exciting study.
Published in JAMA Psychiatry, the clinical trial revealed that 71% of patients experienced a clinically significant response to psilocybin therapies. And 54% of participants met the clinical criteria for “remission of depression.”
In Canada, psilocybin is a restricted and prohibited substance. However, for patients diagnosed with severe PTSD or treatment-resistant depression, it can be available. Physicians can prescribe treatments, particularly for patients who are at risk of self-harm. And when other treatments have not been successful.
For people with treatment-resistant depression, there is new hope on the horizon. The legalization in Oregon may prompt other states to move toward legalizing prescribed psilocybin. And restore the quality of life for millions of Americans struggling with TRD.