Understanding Treatment Resistant Depression
Depression is experienced by almost everyone at some point in their lives. Although almost all cases of depression are treatable, some cases do not respond to common modes of depression treatment. Treatment Reistant Depression or Treatment Refractory depression (TRD) is used in clinical psychiatry to describe cases of depression that do not respond to sufficient courses of at least two different antidepressants.
For treatment of TRD, usually and traditionally involved ECT or electro convulsive therapy and use of non-standard medications. New technologies such as transcranial magnetic simulation are being studed as a safer alternative. TRD may also be treated with more invasive treatment methods like Vagus Nerve stimulation.
Low doses of lithium or thyroxine or more recently olanzapine and other atypical antopsychotics are added to traditional antidepressants as these show promise in treating TRD. But these come with serious side effects. Stimulants such as amphetamines and methylphenidate are also used but these have a high potential for abuse. But for people who have chronic severe depression who do not have any addictive personality traits or heart problems, psychostimulants are used as they are found to be effective for patients who have failed to respond to traditional antidepressant drugs. Partial response and non response to antidepressant medications occur in 10 to 30 percent of the cases. Recurrence of depression symptoms while still taking antidepressant medication is also possible. Five strategies commonly used for treatment of partial response and non response to antidepressant therapy are optimization, drug substitution, combination therapy, electroconvulsive therapy and augmentation therapy.
Rational depression is a type of depression that is guided by negative rationalizations. This particular type of depression is sometimes unresponsive to traditional psychotherapy for depression. This assertion is often denied by cognitive therapists, who deny that this form of depression even exists. They posit instead that depression is a result of distorted thought patterns. Rational depression may lead to rational suicide, which is something for therapists to be watchful for. More mental health information is available on the Chicago Psychotherapist site, a repository of psychological resources.