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Do I Have Treatment-Resistant Depression?
Theodora Blanchfield
If you find that your depression medication isn’t working, you may be starting to feel anxious or frustrated. Trying a series of new medications can be a drain on anyone, especially if you’re still dealing with the symptoms of depression. If you’re asking why you can't find a medication that works, know that you are far from the only person asking this question.
Although many people do respond to common depression treatments, such as medication, talk therapy, or a combination of the two, it can take a while to find a treatment that works for you. For some, it eventually becomes clear that depression isn't getting better with medication, and it may be time to look for a different type of treatment. If that's the case for you, you may have treatment-resistant depression (TRD). Read on to learn what TRD is and what you can do if you think you may have it.
What Is Treatment-Resistant Depression?
TRD isn't an official diagnosis. Instead, it's a term used to describe depression that doesn't respond to two or more medications. If your medication isn't helping, you're not out of options—even if it feels that way. It is common to not find relief with the first depression medication you try. In fact, it's estimated that only half of people with depression respond to their first medication trial.
Some people may experience partial relief with medication, meaning you may still face residual symptoms such as sleep disturbance, lack of interest in activities, or poor concentration. At times, this partial relief is made less beneficial by intolerable side effects like stomach pains, low libido, or insomnia—all on top of residual depression symptoms. There are also some cases where symptoms may seem to get worse after each treatment attempt. If these situations sound familiar to you, remember that you still have options, and there is hope.
Do I Have Treatment-Resistant Depression?
On top of the feelings that depression normally brings, trying several treatments and failing to find results probably brings feelings of hopelessness, frustration, or despair. You may feel like you’re the only person who can't feel better with treatment, but you're actually in good company—few people find something that works on the first try.
Typically, it takes
four to six weeks for someone to fully respond to medication, so your doctor will want to make sure you've given your current treatment enough time to work. After that time frame has passed, your doctor will likely want you to try another type of medication. A doctor will conclude that you have TRD after you've tried at least two depression medications.
If you think you may have TRD, contact your doctor. Changing a medication routine on your own can be dangerous. Your doctor will also check to see if you have the right dosage and are taking your medication correctly. They might want to try a different class of medication, such as switching from a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake Inhibitor (SNRI), or add on a medication (called adjunct therapy) if you are experiencing partial relief.
What Are My Options If I Have TRD?
You have many more options than you think if your symptoms of depression are not getting better with medication. There are many treatment possibilities for those diagnosed with TRD. Some of these options include electroconvulsive therapy, vagus nerve stimulation, ketamine, and
transcranial magnetic stimulation (TMS). Of these treatments, TMS is arguably the least invasive, as it doesn't require any sedation and doesn't cause any drug-related side effects.
If you're not sure where to turn next for depression treatment, it may be time to consider an alternative treatment. At Greenbrook, we're here to help you figure out your next step together. You might find that there are far more solutions for TRD than you think.
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Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for your nasal esketamine treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT), so nasal esketamine is probably a new treatment experience for you. If you're wondering what it's like to start nasal esketamine and get ready for your first session, keep reading. Getting Started with the Nasal Esketamine Treatment As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether nasal esketamine is a good fit for you. Alternatively, you can schedule your esketamine nasal spray consultation with a treatment center (such as Greenbrook) that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS). At Greenbrook's REMS-certified nasal esketamine treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine treatment is right for you. Certain conditions, including blood vessel disease and a history of psychosis, may make treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine provider before beginning treatment. If the medication is deemed a good fit, you’ll receive your prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard (oral) antidepressant along with your nasal esketamine treatment. There are two important regulations to note when it comes to preparing for treatment: Each treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray. You cannot drive during the rest of the day after treatment and must arrange for transportation. These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your treatment schedule. In addition, if you’re wondering what to bring for the treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period. What to Expect During Nasal Esketamine Treatment On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in. Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real nasal esketamine sprayer but does not release any medication. The Care Team will encourage you to use the restroom and set up your preferred environment in your private treatment bay or room. Some patients like reduced lighting, for example, while others don’t request light adjustments. You’ll complete a depression scale before each treatment session. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you. Each sprayer contained 28mg of Spravato esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary. Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate. After your dose, you’ll be encouraged to lie back in your comfortable recliner. While most patients enjoy a quiet setting, Greenbrook is prepared to accommodate patients with a more animated reaction to the medication. You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook's Care Team is readily available if you need assistance. How to Prepare for after your Nasal Esketamine Treatment Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after nasal esketamine treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll have treatment twice a week. Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information. While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine patients begin feeling relief from depression symptoms within hours of their treatment. Other Tips in Preparing for Your Nasal Esketamine Treatment At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each treatment session as an opportunity to relax and take care of your mental health. If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for each treatment session. Schedule A Free Consultation To get started with nasal esketamine, schedule your free consultation today.
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