Depression has become an all-too-common problem in modern life. Symptoms can be mild to debilitating. People living with depression may seem “normal” on the outside, but inside, they are wrestling with feelings of sadness, apathy, guilt, and hopelessness.

Treatments for depression typically include at least one medication and some form of psychotherapy, such as cognitive behavioral therapy or interpersonal therapy. Other modalities like EMDR and dialectical therapy may also be recommended.

Lifestyle changes such as exercising more, getting healthy amounts of sleep, and eating a varied diet filled with fresh, non-processed foods are good suggestions. However, little actions like going for a walk can seem impossibly big when you are depressed.

A combination of medication, therapy, and lifestyle changes may be enough to alleviate the symptoms of depression in some people but not those who have treatment-resistant depression.

For those with treatment-resistant depression, finding treatments beyond what is considered traditional care can be a challenge. However, science-backed alternatives are available. These advanced treatments are helping people across the U.S. find relief from the symptoms of depression and enjoy life again.

What Is Treatment-Resistant Depression?

Finding a successful treatment or combination of treatments for depression can sometimes be challenging. Medications that work well for one person won’t always be helpful for someone else. Some experimentation with antidepressants and dosage may be necessary to discover what works for you.

While this can be frustrating, it’s not the same as treatment-resistant depression (TRD). According to Johns Hopkins Medicine, around 30% of all people living with major depressive disorder are considered treatment-resistant. TRD is defined as lingering symptoms of depression after patients have taken multiple antidepressants.

There are many reasons why an individual might not respond to medication. There may be other risk factors or habits that need to be explored. For example, hypothyroidism can aggravate depression, and using recreational drugs or alcohol can affect the way your body reacts to antidepressant medication.

Therapeutic Options for Treatment-Resistant Depression

The temptation to give up hope when you have treatment-resistant depression is understandable. Depression saps your energy and can make it hard to complete simple daily tasks. Researching and locating new therapies may seem like an impossible task.

The following options include well-tested and FDA-approved therapies. Unlike medications that you may need to take for several weeks or months before knowing if they are helpful, the effects of these advanced therapies are almost immediate. In some cases, you will know if a therapy is effective after a single treatment.

Deep Transcranial Magnetic Stimulation

Deep transcranial magnetic stimulation (Deep TMS) is a non-invasive, FDA-approved treatment for obsessive-compulsive disorder, major depressive disorder, and other types of depression. Deep TMS uses electrical impulses to regulate the production of neurotransmitters.

Studies have found TMS to be effective for treating depression either alone or with pharmacotherapy. It is considered safe for almost everyone, including pregnant patients and the elderly. During a Deep TMS session, the patient wears a helmet that sends magnetic pulses into specific brain areas.

The procedure is non-invasive, though you may hear or feel repetitive tapping coming from the cushioned helmet. The assessment for Deep TMS may take up to 90 minutes and includes mapping the brain so that the clinician knows where to focus the magnetic stimulation. Subsequent appointments last around 20 minutes. In clinical settings, Deep TMS has been proven helpful for three out of four clients.

Ketamine-Assisted Therapy

You may have heard of ketamine but not realize it was approved by the FDA for the treatment of major depression in 2019. Clinical studies have also found ketamine to be useful in treating post-traumatic stress disorder, bipolar depression, suicidal ideation, and other conditions.

Ketamine was originally developed to be used as an anesthetic and a painkiller. The medication acts as an n-methyl-D-aspartate agonist (NMDA). Ketamine alters the function of NMDA receptors in the brain’s glutamate system. Neurotransmitters in the glutamate system are partially responsible for mood regulation and for causing mental health concerns such as depression.

By changing the way the NMDA receptor interacts with glutamine, ketamine can relieve symptoms of depression and help regulate mood. Very small doses of the medication are used during ketamine therapy. Some clients report experiencing the following sensations and responses after a treatment:

  • Happiness
  • Reduced pain
  • Reduced fear
  • A feeling of detachment and floating
  • Altered ways of thinking
  • Euphoria

These sensations are only temporary and typically wear off within a few hours after the session is over. When paired with psychotherapy and another form of counseling, the positive effects of ketamine therapy are long-lasting for some people.

A study published in the New England Journal of Medicine found that 55% of those who received ketamine during a clinical trial experienced sustained improvement in their treatment-resistant depression symptoms. Ketamine is a powerful drug, but it is safe when administered by experienced clinicians in a clinical setting.

Hyperbaric Oxygen Therapy

Every cell in the body is dependent on oxygen to heal, including brain cells. Hyperbaric oxygen therapy (HBOT) supercharges the lungs with two to three times more oxygen than is available from normal air. The treatment of depression is an off-label use for HBOT.

During a hyperbaric oxygen therapy treatment, the client sits or lies in a special enclosed chamber and breathes normally for the session. Sessions can last up to two hours.

Clients are encouraged to bring a book or headphones to listen to their favorite music or podcasts. Many clients opt to relax and take a nap during this non-invasive therapy.

HBOT is an evolving field. One study that included participants with a spinal cord injury and depression concluded that HBOT was as effective for treating depression symptoms as psychotherapy. One theory is that HBOT mobilizes neurotransmitters to aid with mood regulation.

Hyperbaric oxygen therapy has been shown to be effective in reducing pain, especially musculoskeletal pain. People who are struggling to cope with depression that is linked to physical pain may find relief from both conditions with HBOT.

Stellate Ganglion Block

A stellate ganglion block (SGB) involves injecting medication into a nerve bundle at the bottom of the neck known as the stellate ganglion. The treatment relieves chronic neuropathic pain and helps minimize chronic post-surgical pain and other conditions.

Researchers have been collecting evidence about the use of a stellate ganglion block for post-traumatic stress disorder since 1990. It is believed that an SGB can reboot the sympathetic nervous system (which regulates fight or flight) to a pre-trauma state — much in the same way a computer gets rebooted.

SGB drastically reduces the amount of norepinephrine levels and may relieve PTSD symptoms in as little as 30 minutes. Not everyone experiencing treatment-resistant depression is suffering from PTSD or has experienced great trauma. For those who have, SGB may offer new hope for healing.

Stellate ganglion block is a minimally invasive procedure that is safe for most people. Bringing the fight or flight response back to a pre-trauma state can relieve symptoms in as little as one treatment. SGB is not a stand-alone therapy for treatment-resistant depression, but it can be effective when combined with other depression treatments.

qEEG and Neurofeedback

Combining quantitative electroencephalogram (qEEG) with neurofeedback may help retrain your brain in real-time. Clinicians use qEEG to measure a brain’s wavelengths and create a 3D rendering of it. Neurofeedback reorganizes and regulates brainwave frequencies.

Neurofeedback is a safe, non-invasive procedure that’s FDA-approved for stress reduction. Pairing both qEEG and neurofeedback together may impact depression, anxiety, stress, and other mental health disorders by helping the central nervous system reorganize itself.

Neurofeedback works by providing feedback from a program that assesses the patient’s brainwave activity. The patient can then learn to recognize and modify thoughts that may worsen depression. Training individuals to regulate their brainwave patterns empowers them to fully participate in their healing and not feel so dependent on pharmaceutical therapies.

In addition to reduced depression symptoms, undergoing neurofeedback may help improve your ability to focus, stabilize your moods, and promote better sleep.

Virtual Therapy

The need for mental health care in recent years has highlighted the importance of virtual therapy. With virtual therapy, getting help for mental health concerns no longer depends on your ability to find a qualified therapist you feel comfortable with in your locality.

People who live in rural areas, those with transportation or physical challenges, and those who are concerned about privacy can find there are too many obstacles to overcome in their search for mental health support.

Virtual therapy makes it possible for anyone to find a therapist who can help them cope with treatment-resistant depression and other issues. Virtual therapy has become so popular that 56% of people transitioned from traditional in-person therapy to virtual therapy once it became widely available, according to Verywell Mind.

Virtual therapy is private, easy to access, and often less expensive than in-person therapy.

Who Qualifies for Advanced Treatments?

Most healthy people are good candidates for advanced depression treatments. Look for reputable clinics with qualified healthcare providers. Before scheduling any advanced option, you will need to undergo a health assessment. A brain mapping appointment is necessary before a therapeutic session is possible for Deep TMS.

It is not necessary to have your current provider refer you to a clinic where advanced treatments are provided, but a reference could make a difference in whether a procedure is covered by your insurance or not.

If you’re curious about trying an advanced treatment, schedule an assessment. A clinician can help you understand which, if any, treatments may be helpful for treatment-resistant depression. Your treatment history and current symptoms are factors when deciding which therapies offer the most hope for symptom improvement.

Don’t assume that you will not qualify for or can’t afford non-traditional treatments or that they won’t work for you. Advanced therapies are helping thousands of people find relief from depression symptoms.

The search for effective mental healthcare isn’t always easy, but improving or eliminating the symptoms of depression is worth the challenge.

Explore Options for Treating Treatment-Resistant Depression

Treatment-resistant depression affects around 30% of all people who’ve been diagnosed with depression. The term doesn’t mean an individual is resisting treatment; it means the disorder is not responding to traditional treatments as well as expected.

Medications and some form of talk therapy may provide some relief, but if you’ve been trying pharmaceutical protocols and attending therapy sessions for at least six months without a marked improvement in your symptoms, you may have treatment-resistant depression.

Traditional therapies may help most people, but they aren’t the only options. Advanced treatments like hyperbaric oxygen therapy, ketamine therapy, deep transcranial magnetic stimulation, and other options are helping people manage their mental health and get back to enjoying life fully.

Contact Plus by APN by phone at 424.644.6486 or fill out our confidential online contact form to learn more about the services and advanced therapies we offer.

References

  • Feng, Juan-Juan, and You-Hui Li. “Effects of hyperbaric oxygen therapy on depression and anxiety in the patients with incomplete spinal cord injury (a STROBE-compliant article).” Medicine vol. 96,29 (2017): e7334. doi:10.1097/MD.0000000000007334
  • Lipov, Eugene G. “Stellate Ganglion Block: SGB for PTSD Treatment.” Anxiety Disorders and Universal Health Care, 4 Mar. 2024, www.anxiety.org/stellate-ganglion-block-sgb-for-ptsd-research-update#:~:text=Placing%20an%20anesthetic%20agent%20on%20the%20stellate%20ganglion%2C,its%20pre-trauma%20state%2C%20similar%20to%20a%20computer%20reboot.
  • “Ketamine versus ECT for Nonpsychotic Treatment-Resistant Major Depression.” The New England Journal of Medicine, www.nejm.org/doi/10.1056/NEJMoa2302399. Accessed 2 Sept. 2024.
  • Ramos, Carolina S., et al. “The Therapeutic Effects of Ketamine in Mental Health Disorders: A Narrative Review.” Cureus, vol. 14, no. 3, 2022, https://doi.org/10.7759/cureus.23647. Accessed 2 Sept. 2024.
  • Somani, Aditya, and Sujita K. Kar. “Efficacy of Repetitive Transcranial Magnetic Stimulation in Treatment-resistant Depression: The Evidence Thus Far.” General Psychiatry, vol. 32, no. 4, 2019, https://doi.org/10.1136/gpsych-2019-100074. Accessed 2 Sept. 2024.
  • Spiegel, Brett. “A Verywell Report: Americans Find Strength in Online Therapy.” Verywell Mind, Verywell Mind, 9 Nov. 2020, www.verywellmind.com/americans-turn-to-online-therapy-for-strength-5085208#:~:text=In%20fact%2C%2056%25%20of%20people%20surveyed%20transitioned%20from,began%20online%20therapy%20in%20the%20last%20three%20months.
  • “Stellate Ganglion Block.” Cleveland Clinic, 16 July 2024, my.clevelandclinic.org/health/treatments/17507-stellate-ganglion-block.