What is treatment-resistant depression?

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Sometimes, feeling sad or hopeless is a normal and natural part of life. This can happen to everyone. However, for people with depression, especially treatment-resistant depression, these feelings can become intense and long-lasting, affecting physical health as well as social life.

1. What is treatment-resistant depression?

If you have been treated for depression but your symptoms are still not improving, you may have treatment-resistant depression.
Generally, taking an antidepressant or going to counseling (psychotherapy) will help ease the symptoms of depression for most people. However, with treatment-resistant depression, standard treatments are not enough. These common treatments for depression may not help much, or symptoms may improve slightly but keep coming back.
The identification of treatment-resistant depression is a complex and difficult process. Psychiatrists need to review a patient's complete medical history and may:
Ask about life situations that may have contributed to worsening depression; Review the patient's response to treatment, including medications, psychotherapy, or other treatments tried; Review all medications you are taking, including over-the-counter medicines and herbal supplements; Exploiting accurately whether the patient is taking medication as prescribed or not, following other treatment steps or not; Consider physical health conditions that can sometimes cause or worsen depression, such as thyroid disorders, chronic pain, or cardiovascular or neurological problems; Consider a diagnosis of another mental health condition, such as bipolar disorder, cardiac arrhythmia or personality disorder... that contributes to unresolved depression. Symptoms of treatment-resistant depression can range from mild to severe and may require several systematic tests to identify.

2. Drug strategies for treatment-resistant depression

If you've tried antidepressants and it doesn't work, don't lose hope because your doctor may not have prescribed the right dose, type of drug, or combination of drugs.
Some medication strategies for treatment-resistant depression that may be effective include:
Giving current medication more time to work: Antidepressants and other commonly used antidepressants It takes 4 to 8 weeks for full effect and side effects may subside. However, for some people, sometimes it takes even longer. Increase dose if indicated: Because each patient responds to medication differently, it may be more effective to get a better effect from a higher dose of the drug than is normally prescribed. However, it is important to consult with your doctor, do not change the dosage on your own as several factors are involved in determining the appropriate dose. Switching antidepressants: For some people, when the first antidepressant tested doesn't work, it's possible to switch to another that's more suitable for them. Add another antidepressant: Your doctor may prescribe 2 different antidepressants at the same time, to better control the brain chemicals involved in mood. These chemicals are neurotransmitters including: Dopamine, serotonin, and norepinephrine. Add a medication to treat a comorbid condition: Your doctor may prescribe a medication commonly prescribed for other physical or mental health problems along with an antidepressant you're taking. These options may include: Antipsychotics, mood stabilizers, anti-anxiety medications, thyroid hormones.

3. Consult psychological counseling therapy to treat depression

Psychological counseling or psychotherapy by a psychiatrist, psychologist or mental health professional can be very effective for treatment-resistant depression. For many people, psychotherapy combined with medication can work best.
In fact, this non-drug approach can help identify underlying worries that are adding to a person's depressive symptoms. In working with a therapist, people can also learn specific behaviors and plans to overcome their depression.
Some psychotherapies that can help people with treatment-resistant depression include:
Finding better ways to cope with life's challenges; Coping with past emotional trauma; Manage relationships in a healthier way; Learn how to reduce the impact of stress in your life; Address stimulant use issues. In cases where counseling has not been as helpful as desired, continue patiently with psychotherapies for more advanced depression, which may include:
Cognitive behavioral therapy, which helps people the disease identifies and changes negative or misleading thought patterns, and teaches skills to respond to life's challenges in a positive way. Acceptance and commitment therapy helps patients maintain positive behaviors, even in the face of negative thoughts and feelings. Interpersonal psychotherapy, which focuses on solving relationship problems. Family or marriage therapy, which deals with problems involving family members, sometimes requires a spouse or partner to participate in counseling. Dialectical behavioral therapy, which helps build acceptance strategies and problem-solving skills. Behavioral activation therapy helps patients gradually reduce avoidance and self-isolation, increase participation in favorite activities, and improve mood.

4. Invasive measures in treatment-resistant depression

If medication and psychotherapy are not effective, the psychiatrist can talk to the patient and family about invasive treatment options:
Repetitive transcranial magnetic stimulation: Use Uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. Intravenous ketamine injection: Low doses of ketamine are used to provide rapid relief of intractable depressive symptoms and to maintain effects for days to weeks. Electroconvulsive therapy: During sleep, a carefully measured electrical current is passed through the brain, intentionally causing a brief, small seizure to change brain chemistry, resulting in a rapid reversal. symptoms of major depression. Vagus nerve stimulation: Using a device implanted in the chest that is connected by a wire to the vagus nerve, which transmits signals to the brain's mood control centers, can improve symptoms. depression.

5. Supporting conditions for optimal treatment of depression

5.1 Strictly adhere to the treatment plan Take the right medicine at the right dose and time of day. Don't skip follow-up appointments or counseling sessions even if you feel well. If voluntary, depressive symptoms may return and the person may experience withdrawal-like symptoms. In cases where side effects or drug costs are a limiting issue, talk to your doctor for a better option. 5.2 Stop drinking alcohol or using drugs Many people with depression drink too much alcohol or use recreational drugs, marijuana. In the long run, alcohol and drugs make depression worse and more difficult to treat.
If you cannot stop drinking or using drugs on your own, consult your doctor or mental health professional. Treatment for depression is unlikely to be successful until stimulant withdrawal is achieved.
5.3 Manage stress Relationship problems, finances, life, unhappy work, and more can all contribute to stress, which in turn exacerbates depression.
Try stress reduction techniques like yoga, tai chi, meditation, mindfulness, muscle relaxation or journaling to jot down thoughts in your head to feel lighter.
5.4 Get a good night's sleep Not getting a good night's sleep can worsen depression. Both the amount of time and the extent to which you get a good night's sleep can affect your mood, energy levels, ability to focus, and resilience to stress.
If you're having trouble sleeping, research ways to improve your sleep habits or ask your doctor or mental health professional for advice.
5.5 Exercise Regularly Exercise has a direct effect on mood. Even physical activity like gardening or walking can reduce stress, improve sleep, and ease symptoms of depression.
In short, suffering from treatment-resistant depression is a torment for the patient, sometimes affecting his family and loved ones around him. At this point, treating depression can be difficult, but not impossible. Don't waste time with methods that are only partially effective or methods that work but cause intolerable side effects. A comprehensive cooperation in all aspects, between patients, doctors and society, will help treatment-resistant depression have a better chance to improve in a more sustainable way.

Currently, the Psychology Clinic - Vinmec International General Hospital officially came into operation in April 2019, has the function of examining, consulting and outpatient treatment of psychological problems and psychological health. . With modern equipment, Vinmec Mental Health Clinic is currently cooperating with experienced professors and experts:
MSc. Doctor Nguyen Van Phi - Psychologist, Vinmec Times City International Hospital: with 7 years of experience working as a lecturer in Psychiatry - Hanoi Medical University, Doctor Psychiatrist at Hanoi Medical University Hospital & Central Geriatric Hospital, and a member of the Vietnam Psychiatric Association. MSc. Dr. Pham Thanh Luan - Psychologist, Vinmec Times City International Hospital: with 5 years of experience in research, examination and treatment of Psychiatric diseases, trained at prestigious universities trust, practice in-depth expertise in the French Republic. MSc. Doctor Nguyen Trong Hien - Psychologist, Vinmec Times City International Hospital: with 6 years as a lecturer in the Department of Psychiatry - Hanoi Medical University and Central Geriatric Hospital, together with Dr. Experience in research, examination and treatment of diseases in Psychiatry such as: emotional disorders, stress-related disorders and body dysmorphic disorders, developmental disorders in children, adolescents & childbirth .... Along with the implementation of psychological tests, intensive psychotherapy for diagnosis and treatment, in order to bring the best medical examination and treatment effect.

Please dial HOTLINE for more information or register for an appointment HERE. Download MyVinmec app to make appointments faster and to manage your bookings easily.