Treatment Resistant Depression
Depression is a brain disease that affects one out of every seven people. Medications and psychotherapy (“talk therapy”) remain the mainstays of treatment, but not all patients fully respond or achieve remission (become symptom-free) when treated with medications. Recent evidence from a large multi-site national research study shows that only one-third of depressed individuals are symptom-free after the first course of antidepressant treatment. Furthermore, only about one-quarter of patients are in remission after treatment with a second antidepressant. Individuals who have not yet improved after trying numerous individual medications and/or psychotherapy techniques, are often categorized as having treatment resistant depression (TRD).
The Depression Center’s Treatment Resistant Depression Program, funded in part by a generous gift from the Noble Foundation of Wooster, Ohio, is part of the Center’s Comprehensive Mood Disorders Clinics (CMDC). The CMDC provides extensive evaluations and innovative clinical programs for people suffering from TRD.
Melvin McInnis, M.D., director of the CMDC, says, “There has been a shift in thinking about the treatment of depression. Remission and complete wellness are our goals. Getting partially or mostly better is not good enough.”
To address the needs of patients with TRD, physicians turn to long-standing treatments as well as those that are relatively new. One option is to combine different kinds of mood-stabilizing and anti-psychotic medications. Another option, electroconvulsive therapy (ECT), is often used for patients with TRD and is the treatment that has the best evidence of achieving remission. In addition to these approaches, emerging strategies that offer hope for TRD include vagus nerve stimulation (VNS), repetitive transcranial magnetic stimulation (rTMS) and deep brain stimulation (DBS). These new techniques are sometimes referred to as neuromodulation treatments because they affect, or modulate, brain functioning.
The Depression Center is incorporating a range of neuromodulation techniques in the evaluation and treatment of patients with TRD who are seen in the Comprehensive Mood Disorders Clinics. Consistent with the Center’s overall mission, the strategy with respect to TRD is to prevent its development by detecting and treating it earlier and more effectively, achieving remission and preventing recurrences and progressions.
