Health and Psychology

One of the types of mental health problems I deal with is treatment resistent depression.  Treatment resistant depression is diagnosed when someone has had psychotherapy that was not effective, or has been on several types of medication which were not effective, or had a combination of therapy and medication and the depression returned or never went away in the first place. 

In cases where a mental health issue like anxiety or depression is "treatment resistant" it's important to ensure that the diagnosis is correct.  Many medical conditions will present with psychological symptoms and depression is one of the more common presentations of a medical illness.  Infection, heart problems, gastointestinal problems, and immune disorders can all contribute to depressive symptoms.  It should be obvious that if someone has a bacterial infection that taking an antidepressant medication or doing therapy for the depression isn't going to help until the infection is eliminated. 

Atypical depression can be identified as a depression that isn't responding to adequate treatment.  This means that adequate treatment needs to be defined.  There are several types of psychotherapy that have a substantial research base for efficacy for treatment of depression.  These include Cognitive Behavioral Treatment (CBT), Mindfulness Treatment (MT), Behavioral Therapy (BT), Rational Emotive Therapy (RET), group therapy with a cognitive focus (GT), Cognitively Oriented Marital Therapy (COMT), Emotionally Focused Marital Therapy (EFMT), Insight Oriented Marital Therapy (IOMT), Family therapy with a cogntive focus or an educational focus (FT), Interpersonal therapy (IPT) and combinations of evidence based therapy and medications.  There are several classes of medications for depression, including tricyclic antidepressants, SSRIs, SNRIs, MAO inhibitors, atypical antidepressants, antiseizure medications, and antipsychotic medications. Supportive psychotherapy or psychoanalysis have not been shown to be effective.

Medical conditions that may initially present with depression include infection, cancer, heart problems, diabetes, multiple sclerosis, alzheimer's disease, autoimmune disorders, thyroid disorders, polycystic overy syndrome, malabsorption disorders, and vitamin and mineral deficiencies.

After someone has tried a course of medication and therapy and it hasn't been helpful they may feel like giving up.  Intermittent use of medication, and inadequate or non-evidence based psychotherapy treatment account for a large percentage of treatment resistent depression.  Failure to treat depression into remission is a common cause of depression relapse. 

Once someone starts to feel dessperate or if their symptoms are severe they may consider Electroconvulsive Therapy (ECT) or Transcranial Magnetic Stimulation (TMS).  Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through the brain, deliberately triggering a brief seizure. Electroconvulsive therapy seems to cause changes in brain chemistry that can immediately reverse symptoms of certain mental illnesses. It often works when other treatments are unsuccessful. There is good data on it's effectiveness. Transcranial magnetic stimulation is a procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. Transcranial magnetic stimulation may be tried when other depression treatments haven't worked. This is a newer treatment and data on it's effectiveness isn't yet available.

A health psychologist can help work with you and your treating physician to diagnose you correctly and get your depression into remission.