While depression and other mental health conditions can be overwhelming, confusing, and painful, the good news is that relief is possible and there are more advanced treatment options than ever to help you get there.
Depression can cause you to isolate yourself from others, including friends, family, and medical professionals who can provide help. Most types of clinical depression only abate with treatment, most often medication. Those with Treatment-Resistant Depression (TRD) may need to try multiple medications or advanced therapies such as TMS or esketamine, a prescription nasal spray.
This is also known as “talk therapy” or “psychological therapy.” This method of treating depression involves talking about your condition and related issues with a mental health provider. Different types of psychotherapy can be effective for depression, such as cognitive behavioral therapy or interpersonal therapy.
For many, psychotherapy is often the first type of treatment they receive. If therapy alone does not resolve symptoms or if symptoms seem too severe, the therapist may also recommend medication. As therapists can’t prescribe medication, they’ll recommend or refer the patient to a psychiatrist or psychiatric nurse practitioner for an evaluation. (Primary care providers can also prescribe antidepressant medications, although they typically recommend that new patients see a specialist for their diagnosis.)
Antidepressants are another key treatment for depression and Mindful Health Solutions provides medication assessment and management services as part of a comprehensive treatment plan. Your physician can choose from a variety of antidepressants that act on different neurotransmitters to regulate mood or increase electrical flow among brain cells. If one antidepressant doesn't work well or causes side effects, your clinician may adjust the dosage or have you try another medication that may be better suited to your body chemistry. In some cases, it might be best for you to take more than one medication for your depression.
Your psychiatrist or psychiatric nurse practitioner will evaluate you to see if medication might be a good treatment option, often in addition to talk therapy. Medication can be very effective but may cause side effects and lose effectiveness over time. Also, over 40% of patients taking antidepressants won’t get better regardless of the type or number of drugs they take, signaling possible TRD. If this is the case, your clinician may recommend a second-line treatment to replace or complement medication, such as TMS.
Common side effects include irritability, hostility, agitation, anxiety, panic, nausea, insomnia, restlessness, diminished sex drive/libido, dizziness, weight gain, sweating, fatigue, sleepiness, dry mouth, diarrhea, constipation, headaches, mood swings and aggression.
TMS is a non-invasive therapy with few side effects, prescribed for patients who suffer from TRD and haven’t responded favorably to medications alone. TMS is effective in approximately 60% of patients, making it twice as effective as antidepressant medications.
Although the vast majority of patients respond to some combination of therapy, medications, and TMS, there are who do not find relief with these treatments. If these therapies don’t work for you, your practitioner will recommend more aggressive treatments, such as Electroconvulsive therapy (ECT).
Common side effects include scalp discomfort, normally described as a tapping feeling.
Esketamine is a prescription nasal spray approved for use in conjunction with an oral antidepressant in adults with treatment-resistant depression (TRD). People who are currently struggling with major depressive disorder (MDD) may have TRD if they have not responded adequately to or have experienced side effects with at least two different antidepressants of adequate dose and duration.
Although the majority of patients respond to some combination of therapy, medications, and esketamine, there are those who do not find relief with these treatments. If these therapies don’t work for you, your practitioner may recommend other treatments such as Electroconvulsive therapy (ECT).
The most common side effects of esketamine include: dissociation, dizziness, nausea, sedation, anxiety, lack of energy, increased blood pressure, and feeling drunk. Because of these risks, esketamine is only available through a restricted program called the SPRAVATO™ REMS Program. For patients to receive this medication, all doctors, pharmacists, and patients must agree to, understand, and carefully follow the requirements of the SPRAVATO™ REMS Program.
Side effects typically occur within and are limited to the first two hours after the administration of the medication.
During ECT, minor electric currents are passed through the brain, intentionally triggering a brief seizure. This treatment must be performed under general anesthesia and typically requires a stay in the hospital, although it is more frequently being performed on an outpatient basis. Although early ECT procedures caused severe side effects, refinements have been made to render the treatment more tolerable.
ECT can be effective for those who don’t respond to most treatments, though it does causes numerous side effects, including short-term memory loss, long-term memory loss, and a rise in heart rate and blood pressure. A physical exam and basic laboratory tests, including an electrocardiogram (ECG), are necessary before starting ECT to assure that no medical problems are present that could interfere with the safe administration of the procedure.