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FDA-cleared, non-medication depression treatment
Sign That Your Major Depressive Disorder Treatment Plan Isn't Working
Daniel Hageman
Getting on a major depressive disorder treatment plan is a great step forward, but it can be hard to know if it's working—or if it should be working better.
While the right boxes may be checked on your plan, it can still feel like the journey is far from over. Maybe you're seeing some progress, but you'd hoped to see more. You may not know if you should expect things to continue improving or if this in-between state is the best you can hope for. No matter how long your treatment journey has been, it's important to not settle for "better." You have every right to seek new treatments until you truly feel that your depression is resolved. Here's a look at some signs that your major depressive disorder (MDD) treatment plan might not be working.
1. Only Some of Your Symptoms Have Been Resolved
If your MDD treatment plan is successfully taking the edge off your worst depression symptoms, you might be tempted to count your blessings, even if other symptoms continue to bother you. The reality is that a depression treatment plan that is only partially successful isn't a successful depression treatment.
The problem is two-fold. On the one hand, you deserve complete relief, and lingering symptoms can keep you from enjoying full quality of life. On the other hand, research has found that residual symptoms of depressive disorder are major predictors of relapse of depression.
In
some studies, residual symptoms in patients with depression are associated with social functional impairment. This can lead to sustained feelings of isolation and loneliness that continue to contribute to depression. It's important to know that if only some of your symptoms have resolved, much more can be done to help you experience a fuller, more satisfying breakthrough for restoring quality of life.
2. You're Experiencing Reduced Versions of the Same Symptoms
It's also possible to see mixed results when it comes to symptom severity. Many people experiencing depression decide to simply settle for reduced—but not eliminated—symptoms because they are happy to get any kind of relief. Similarly, many who find early success with a treatment option feel excited because they assume that the results will continue to get better and better.
Sometimes, though, an initial reduction in the severity of depression symptoms represents the "peak" level of relief that you'll experience on a given course of treatment. While we can't underestimate how good it is to see a reduction in depression symptoms, staying with a plan just because it worked "a little" is really just settling for less than a resolution to MDD.
3. The Side Effects Are a Burden
Unfortunately, a major depressive disorder treatment plan that includes medications can put you in a position of trading some of your unwanted symptoms for other unrelated symptoms. Some antidepressant medications cause side effects, such as diarrhea, nausea, headaches, and joint pain, that make it hard to get on with daily life. Other side effects are subtler but can detract from the quality of life in big ways. For instance, some medications may contribute to sleepiness that saps your energy and enthusiasm, while others can cause weight gain.
Unfortunately, these side effects can make you feel hopeless or out of control just when you were hoping to turn a corner. If side effects are creating new problems in your life, you might want to talk to your provider about different medications or treatments for major depressive disorder that won't alter you on the physiological level.
4. Your Depression Has Morphed to a State of High Excitement
Some people feel relief from anxiety that is replaced by feelings of overexcitement when taking medications for depression. Some might describe this experience as feeling "high." There's even a chance that you may have feelings of euphoria, invincibility, or mania. "During a manic episode, continuing antidepressant medication serves no purpose other than to contribute to or exacerbate mania symptoms," according to research published in Federal Practitioner.
While some people may confuse feelings of agitation and restlessness as signs that the fog of depression is lifting, it's actually possible that something called serotonin syndrome is occurring as a result of a new medication. It's important to let your care provider know if you're feeling overly excited in a way that doesn't match your personality. This could be a sign that your medication is not working as intended.
Rethinking Your Major Depressive Disorder Treatment Plan: Consider TMS
Living with reduced severity of depression symptoms is still living with depression. If you're left unsatisfied with talk therapy or antidepressants, it may be time to explore new treatments for major depressive disorder.
One option to consider is transcranial magnetic stimulation (TMS) therapy. This therapy is FDA-cleared for major depressive disorder and uses non-invasive devices that deliver gentle magnetic pulses to stimulate areas of the brain tied to mood.
Because it's not considered a "front-line" treatment like therapy or medications, TMS can be a great fit for those who haven't seen satisfying results from those other approaches. "The goal here is complete remission of your symptoms," says Dr. Geoffrey Grammer, chief medical officer at Greenbrook TMS. "And a lot of times, if we add TMS therapy to the medication that's had a partial effect, then the combination of the two is enough to completely relieve someone's symptoms." To learn more about whether TMS therapy can help you find true relief from depression, reach out for a no-cost consultation.
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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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