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Doctor insights on: Treatment Resistant Depression

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Is there treatment-resistant depression?

Is there treatment-resistant depression?

Yes: But the definition is usually failure of 2-3 different treatments. Treatment-resistant doesn't mean incurable. Very often people have gotten multiple antidepressant trials without much benefit, but they were all similar medications or too short trials. There are many strategies and combinations as well as ECT that often work when others fail. See my book, psychiatry in techno colors. ...Read more

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Dr. Pamela Pappas
4,567 doctors shared insights

Depression (Definition)

Depression is a mood disorder that can affect behavior and emotions. Symptoms of depression include feeling down most of the time, losing interest in previously enjoyable activities, increase or decrease in appetite or weight, sleeping more or less, becoming easily agitated or lethargic, feeling worthless, feeling guilty, having difficulty concentrating, thinking more about death and dying. Depression can sometimes result in suicidal thoughts and plans. In this case, emergent ...Read more


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What is considered treatment resistant depression?

What is considered treatment resistant depression?

Failure of one med: Treatment-resistant depression (TRD) typically refers to inadequate response to at least one antidepressant trial of adequate doses and duration. TRD is a relatively common occurrence in clinical practice, with up to 50% to 60% of the patients not achieving adequate response following antidepressant treatment. ...Read more

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What's the best treatment for, treatment resistant depression?

What's the best treatment for, treatment resistant depression?

No 1 "best" one: There are many treatment augmenting strategies for treatment resistant depression. One that seems promising but has less side effects is l-methyl folate (folic acid), (folic acid) since many with depression have abnormalities of folate (folic acid) metabolism that can worsen depression. Also there are transcranial magnetic stimulation and ect. Ongoing psychotherapy of course. Plus many complementary forms of medicine as well. ...Read more

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What are your options when you have treatment resistant depression? Any meds of last resort?

What are your options when you have treatment resistant depression? Any meds of last resort?

Depression: may be treated with different classes of antidepressants( selective serotonin reuptake inhibitors, serotonin-norepineprhine reuptake inhibitors, mood stabilizers, atypical antipsychotics & bupropion. Tricyclic antidepressants and monoamine oxidase inhibitors are often used off- label now (rather than for depression). Treatment option include > ...Read more

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What is your advice regarding divorcing while having major treatment resistant depression? Could it help the depression?

What is your advice regarding divorcing  while having major treatment resistant depression? Could it help the depression?

Uncertain: Divorce can have both effects on depression. It really depends on the marriage and the depression. I strongly recommend talking with a psychotherapist at length before making the decision to divorce and perhaps consider couples counseling in addition to individual therapy for yourself. Major depression and marital dissatisfaction are separate entities that can/do contribute to each other. ...Read more

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How is the success of Lithium Therapy in unipolar treatment resistant depression?

How is the success of Lithium Therapy in unipolar treatment resistant depression?

It may help...: Lithium has a fair amount of research behind it--it is a known strategy to augment antidepressant treatment and to help prevent recurrence. Patients seem to be afraid of Lithium; but for many people it can be a life-saver. ...Read more

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How is the success of Lithium Therapy in Atypical depression?suffering from unipolar treatment resistant depression.

How is the success of Lithium Therapy in Atypical depression?suffering from unipolar treatment resistant depression.

Treatment : Research suggests that lithium is effective 50% of the time when added to antidepressant medication to augment response in the treatment of depression. ...Read more

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What is the current thinking on BPD and treatment resistant depression? Is there anything new in the pipeline at the moment?

What is the current thinking on BPD and treatment resistant depression? Is there anything new in the pipeline at the moment?

BPD ?: KatieM881~ here are some references for you to read for latest treatment for BPD: http://bipolar.stanford.edu/documents/3.WangNewBP.Rx.MoodD.EdDay10.Final.pdf http://www.nimh.nih.gov/news/science-news/science-news-about-bipolar-disorder.shtml https://www.seroquelxrtouchpoints.com/bipolar-disorder/bipolar-depression-efficacy?source=SERH34439&WT.mc_id=SERH34439&umedium=paid%20search&uadpub=google ...Read more

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How is the tolerability and adverse effect of Moclobemide in treatment resistant depression?if other options didn't work.

How is the tolerability and adverse effect of Moclobemide in treatment resistant depression?if other options didn't work.

Follow directions: Ok if you follow precautions--your other docs won't like it because it interacts with many Meds--I've treated any pts on Nardil & Parnate (tranylcypromine) over the years & it can be done successfully ...Read more

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Has anyone ever heard of a vagal nerve stimulator for treatment resistant depression?

VNS for dep: Yes. I've heard of it, been to a conference on it, and heard dinner programs about it. It is exorbitantly expensive and was considered the end of the line treatment for depression a few years back. In my opinion, tms and some of the newer agents may work just as well. ...Read more

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Do any psychiatrists have experience using ketamine for treatment resistant depression? This seems to be a growingly popular and relatively successful treatment / approach.

Do any psychiatrists have experience using ketamine for treatment resistant depression? This seems to be a growingly popular and relatively successful treatment / approach.

Short term: This is a short term treatment, and has to be repeated in a few days or weeks depending on how long the effects last for you. it has not been FDA approved for long term treatment, and has to be given as an infusion in a monitored setting. It does however act fast, as soon as you get it, which is why it has been looked at as an alternative to traditional SSRIs that take weeks to start working. ...Read more

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I have long-term, treatment-resistant depression, and adult add. My add meds always stop working. Any new add meds i could ask about?

Many options: Not long ago, one medication for ad/hd (stimulants) was used. Today, multiple completely different medicines (with unique mechanisms of action). Behavioral therapies and use of assistive technologies on the web and in smatphones can also make a big difference. Some evidence shows neuro-training and biofeedback approaches to be promising. Talk with your primary doc about an ad/hd specialist. ...Read more

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Can you tell me about effexor, (venlafaxine) remeron & Vyvanse combination - any insight about combination efficacy for treatment-resistant depression or user experiences?

Can you tell me about effexor, (venlafaxine) remeron & Vyvanse combination - any insight about combination efficacy for treatment-resistant depression or user experiences?

Good combo: Some studies suggest that effexor (venlafaxine) and remeron work better together than independently. vyvanse, i'm less enthusiastic about as i feel it doesn't treat depression per se as much as it increases energy/activation. ...Read more

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Would Adderall (dextroamphetamine and racemic amphetamine) help my treatment-resistant depression?

Would Adderall (dextroamphetamine and racemic amphetamine) help my treatment-resistant depression?

Stimulants: are sometimes added to the treatment regimen for recalcitrant depression. I don't know if stimulants would be helpful for you or not (as I don't know you or your history). There are other approaches I would try with my patients before trial of stimulants. ...Read more

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TSH=0.4 uiu/ml,T3=1.2,T4=7.2,can Triiodothyronine be used for Treatment-Resistant Depression?

TSH=0.4 uiu/ml,T3=1.2,T4=7.2,can Triiodothyronine be used for Treatment-Resistant Depression?

Depends: on what the underlying cause is. If treatment resistant depression is due to undiagnosed hypothyroidism, then T3 (liothyronine) is likely to be helpful. More info on http://drfairchild.blogspot.com/2012/12/proper-thyroid-testing.html ...Read more

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Fore treatment-resistant depression. No local psychiatrists prescribe it, so seeking anesthesiologists or pain management physicians .

Fore treatment-resistant depression.  No local psychiatrists prescribe it, so seeking anesthesiologists or pain management physicians .

Seeking doctor: Please contact your local state medical society for referrals. Also consider a virtual consult through HealthTap. TMS therapy is used by some docs. Here's a link https://neurostar.com/?gclid=CNOQvtat7NECFdQ2gQodErgAZQ Peace and good health. ...Read more

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