Depression and resistant depression

Depression is one of the most common mental disorders that can cause significant suffering and loss of productivity. It is characterized by negative thinking, low mood, low energy to work and inability to feel pleasure.

There are several treatment modalities available for depression and it depends on the severity and other associated features of it. Antidepressants are the most common method of treatment. However, around 50% of patients do not achieve satisfactory symptom control with single anti-depressant. It is a very significant failure rate.

Treatment resistant depression (around 40 – 30% of all depressed patients) is usually treated with augmentation (Lithium, Buspiron, Anti psychotics). Some patients need to try different anti-depressant until a responding medication is found.  Other people need Electro convulsive therapy for symptom relief but the effect is short lasting. 

The main reason for above failure rate is the lack of understanding about the mechanism of depression. First Anti-depressant is in fact discovered by an accident. All New anti-depressants are modifications of the original anti-depressant (Imipramine).  None of the newer anti-depressants are superior to Imipramine in terms of Efficacy (“Effectiveness”).

Some clinicians practice regular maintenance ECT for resistant depression (usually once a week). Recent review on published trials regarding maintenance ECT concludes that patients need to be given the choice.  

Sometimes cognitive behavior therapy and supportive psychotherapy help patients to cope with depression.

Another promising finding is the effectiveness of Ketamine (Anesthetic medication) in treating depression. 

Unlike other antidepressants Ketamine relieves depression within hours and mechanism of Ketamine is completely different to conventional anti-depressants. But the effect is short lasting. However, it opens a whole new path for scientists to uncover regarding the mechanism of depression.

Finally it seems there is currently no magic bullet for treatment of depression. But future is not gloomy, because scientists are trying to find out the exact cause for depression and hopefully find a better treatment options. 

Symptoms and treatment of Major Depression