Finding Solutions When Depression Resists Treatment
Taking an antidepressant or going to psychotherapy, or a combination of both, eases depression for most people. But for individuals who experience a form known as treatment-resistant depression, standard treatments provide little or no relief.
Individuals are considered to have TRD if they haven’t responded to an adequate trial of two different antidepressants. Studies indicate that 29% to 46% of patients with major depressive disorder show partial or no response to treatments.
“By the time patients are referred to us, they’ve often tried multiple therapies, pharmacological and nonpharmacological,” said Adrian Jacques H Ambrose, MD, MPH, who with Joshua Berman, MD, PhD, directs the Treatment-resistant Depression Program at Columbia Psychiatry’s Faculty Practice.
“I’ve heard countless patients say that they feel completely hopeless,” Dr. Ambrose added. “They have suffered for months and sometimes years, and since medications and therapy have not worked, they feel like it’s their fault—like they’re broken.”
The Columbia program provides a range of evidence-based services to address refractory depression, starting with a comprehensive evaluation to create an individualized plan for each patient. The clinical team is trained in interventional neurotherapeutic psychiatry, which refers to a collection of nervous system stimulation therapies focused on modulating dysfunctional brain circuitry.
Interventional neurotherapeutic services available to patients include transcranial magnetic stimulation (TMS), electro-convulsive therapy (ECT), esketamine, and ketamine.
“With these treatments, we do see people get better and experience real change,” Dr. Berman said. “Often times, patients will say things like, they’ve gotten their lives back. As a doctor, you really can’t beat that feeling.”