Treatment resistant depression - what should I do?
Q.I have a depression that is, as I see it, treatment resistant. What should I do about it? I have had it for years now and been treated with SSRI. The meds keep me going but the depression is still there. New meds? Electroconvulsive therapy?
A.Have you tried any of the other types of antidepressants? If so, you might want to consider a new procedure now available very selectively called rTMS or Repetitive Transcranial Magnetic Stimulation. It is supposed to be as effective in treating depression as ECT, but without the memory-loss side effects. You might want to read up on the procedure more at http://cbs.medscape.com. The article title is "Magnetic Stimulation Eases Severe Depression." If you're not seeing a psychiatrist - you should be. If you are, and still don't have an answer, you need to find one that will provide you with one. If you need some names, try contacting a university with a good psychopharm research dept in yr area and ask them, if you dont have one locally, try a non local one (Columbia in NYC is a good one), and ask if they can recommend someone in yr area. yes definitely new meds. I would recommend just trashing the SSRIs and just skipping to either Effexor XR...a heavier duty antidepressant. Or better yet, just skip directly to a tricyclic. Maybe Pamelor or Elavil or something. The TCAs have a reputation for being good for severe and treatment resistant depression even though they have more side effects and are more toxic. If the TCA trial fails move on to an MAOI. I would not waste my time with the other newer meds other than maybe Effexor. Id go straight to the old meds if you are treatment resistant. Regarding counseling and depression: I took a full course of counseling with a psychologist — gave it "my all" — graduated, and seven years later am still grappling with the chemical treatment solutions. My therapist had this to say about counseling and I agree with this 100%: Counseling is of enormous help to people with episodic, environmentally-induced depression. In cases of bio-chemical imbalance — recurrent/chronic major depression — counseling can help the patient learn coping skills — it can change the way we view or treat the disease. It can't and won't "solve" the problem. You don't "solve" diseases, you cure or treat them......
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