What to Do if Antidepressants and Therapy Aren't Enough

Depression is a tricky condition that can be difficult to treat, and it’s different for everyone. The usual go-to treatments — antidepressants and therapy — work for many, but not all.

If you’re one of those who haven’t found relief from traditional methods, you might be dealing with what is known as treatment-resistant depression. But don’t worry; there are more options to explore, and Atlanta, Georgia-based physician Dr. Karen Giles at Breakthru Psychiatry Solutions is one of the leading specialists in this field.

Here, she explains what constitutes treatment-resistant depression and the proven treatments that can work even where others have failed.

What constitutes treatment-resistant depression?

We diagnose treatment-resistant depression (TRD) when you’ve tried at least two different antidepressants at the correct dosage and for long enough without success. 

It’s a tough form of depression that interferes with your day-to-day life. Symptoms can include constant sadness or hopelessness, lack of energy, and trouble focusing, but everyone’s experience with TRD is unique, and symptoms can vary.

The limits of traditional treatments

With depression, your physician will often start with antidepressants and therapy or a mix of both. 

Antidepressants

Antidepressants aim to balance the brain chemicals (neurotransmitters) that affect your mood and emotions. They primarily target one or a combination of the following  neurotransmitters: serotonin, norepinephrine, and dopamine. 

Several types of antidepressants, are available, including selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs). Each works slightly differently to influence the levels of neurotransmitters in your brain.

Although antidepressants can be highly effective, they don’t offer an immediate fix. It usually takes a few weeks before you start noticing any mood changes, and it’s crucial to take them consistently as prescribed.

Antidepressants can also come with side effects, which can include nausea, dry mouth, weight gain,sexual dysfunction, and sleep disturbances. 

Therapy for depression

Therapy for depression teaches you new ways of thinking and behaving, or it suggests  changing habits that might be feeding your depression. 

There are several types of therapy, but the two most common in treating depression are cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT).

CBT helps you identify and change patterns of thinking and behavior that might be contributing to your depression. It enables you to recognize negative patterns and teaches strategies to challenge and change them. By altering your thought patterns, you can influence your emotions and behaviors, improving your mood.

IPT focuses on improving negative relationships and social interactions that cause or exacerbate depression. You develop strategies for resolving conflicts, improving communication, and building a stronger social network to reduce loneliness and isolation, common triggers for depressive episodes.

Though therapy can be incredibly effective, it isn’t an immediate solution. Just like taking medication, it requires patience and commitment. You might notice small changes early, but significant improvements usually take longer.

Beyond traditional treatments

If the usual treatments aren’t working for you, it’s time to look at other options, such as transcranial magnetic stimulation (TMS), IV ketamine, or Spravato®. 

Transcranial magnetic stimulation for treatment-resistant depression

When antidepressants haven’t balanced your neurotransmitters and conventional talk therapy hasn’t helped, TMS may be the answer. It’s a painless, noninvasive treatment that uses magnetic energy to stimulate nerve cells in your brain. 

Dr. Giles places an electromagnetic coil against your scalp near your forehead. The electromagnet painlessly delivers a magnetic pulse, stimulating nerve cells in the part of your brain that’s involved in mood control and depression. Because Dr. Giles uses TMS with neuronavigation, she can pinpoint the treatment area, saving significant time and ensuring better results. 

This stimulation impacts how the targeted part of your brain works, which can reduce depression symptoms and improve mood. 

Ketamine infusions for treatment-resistant depression

Ketamine, historically used as an anesthetic in medical settings, has rapid-acting antidepressant effects when administered in low doses.

During a ketamine infusion, Dr. Giles gives you a small dose of the drug intravenously for approximately 50 to 60 minutes. The treatment affects your brain’s N-methyl-D-aspartate (NMDA) receptors, which play a role in mood regulation and the formation of memories. By blocking these receptors, ketamine can potentially reset neural connections that stress and depression have impaired.

Many patients report mood improvement within hours of an infusion, which is significantly faster than the typical response time for traditional antidepressants.

Spravato for treatment-resistant depression

Spravato, the brand name for esketamine, is an FDA-approved innovative treatment option for adults with treatment-resistant depression.

Like ketamine, Spravato blocks NMDA receptors. Research suggests this blocking action on NMDA receptors may activate other receptors, specifically amino-hydroxy-methyl-isoxazolepropionic acid (AMPA) receptors. This activation could improve neural plasticity and synaptogenesis, enhancing your brain's ability to form new, healthier neural connections. 

Unlike IV ketamine, Dr. Giles administers Spravato via a nasal spray.  You come in twice a week for four weeks, then once weekly for four more weeks, and Dr. Giles tapers your treatments while monitoring your condition and progress. 

If you live in the Atlanta, Georgia, area and have treatment-resistant depression, there’s hope. Request an appointment online, or call Breakthru Psychiatric Solutions in Sandy Springs, Georgia, today.