Treatment Resistant Depression

Treatment Resistant Depression
Treatment Resistant Depression

Therapy for Depression & Treatment Resistant Depression in Annapolis, MD

What is Depression?

Close to 20% of Americans live with depression. Depression is a serious condition and is one of the single causes of disability worldwide. It is also on the rise globally.

Depression is not the “blues” or situationally feeling down or in despair. It is not the “depression” that one may feel over the loss of a loved one. It is also not the upset and pain that one may experience over the loss of a career, dreams, or life hopes.

In addition, there continues to be a strong stigma around depression. Some people think it is wrong to be depressed. Is it wrong to have a heart condition? The true depth and seriousness of the condition is often underappreciated. People who have been clinically depressed can very much relate.

The most common symptoms include low mood, social withdrawal, loss of motivation, poor sleep, dramatic changes in appetite, loss of energy, and negatively distorted thinking. There are several types of depression. Major Depressive Disorder, commonly referred to as clinical depression, is typically for most individuals, the most severe.

For a person living with depression simply getting out of bed can be a monumental task

For a person living with depression, simply getting out of bed can be a monumental task. Completing basic chores can feel overwhelming. At its worst, a person can digress into hopelessness, despair, and even a loss of a will to live. The collective weight of these experiences can wear down one’s resolve, further feeding hopelessness.

Depression is complex and the causes are not completely understood. It is commonly understood that depression is caused by a combination of biological, genetic, social, and psychological factors. The significance of each factor varies from individual to individual. The experience of depression can vary widely across individuals.

It is important to never lose sight of the fact that depression is treatable. This truth is ever more a reality as more and better treatments are being developed every day.

A healthy lifestyle can help stave off and help alleviate symptoms of depression. These include exercise, a healthy diet, good sleep, natural sunlight, and strong social connections. Unfortunately, many people who are depressed can find it almost impossible to maintain such beneficial activities.

Full recovery and treatment may require a number of treatments. Medications, psychotherapy, or a combination are most common.

What Exactly is Treatment Resistant Depression (TRD)?

According to NIH, TRD can more informally be applied to “a subset of Major Depressive Disorder which does not respond to traditional and first-line therapeutic options.”

Typically, antidepressant medications are the first-line treatment for individuals with clinical depression and, for many, antidepressants are highly effective.

Unfortunately, only about half of patients prescribed antidepressants show a good response. When an individual undergoes at least two trials of antidepressant medications, meaning at least two antidepressants from two different classes, and does not respond adequately, the person is technically diagnosed with treatment-resistant depression 1 can more informally be applied to any individual who has had years of treatment, medications, psychotherapy, or both, and continues to struggle with clinical depression.

If you have suffered from depression for years despite your best efforts to get help, getting discouraged is understandable. However, depression is treatable.

As I have said previously, everyone experiences depression in unique and different ways. What works for one person may not work for another. It often takes a tweaking of treatments to find what works for you. I guess it can be said that hope, perseverance, and resolve can be one’s greatest assets when it comes to overcoming depression.

So what’s really going on with treatment resistant depression?

People with depression have a problem in brain functioning sometimes caused by chemical imbalances. However, what leads to those imbalances and poor brain functioning?

The truth is, it is often a little of both – nature and nurture.

The distinction between what is biological and what is emotional/psychological is not as large as most people think. The truth is, your life experiences have a very large impact on your brain health.

As I have mentioned before, there is a large correlation between adverse child events and depression in adults. Psychological trauma can impact the brain physically and as well as lead to a life of relational behaviors that can lead to depression.

In fact, in a pilot study done in 2006 looking at the effectiveness of ISTDP in treating TRD, all 10 of the participants had adverse childhood experiences, such as emotional, physical, and/or sexual abuse.

In addition, there is a strong comorbidity (the presence of two issues at the same time) between TRD and personality disorders. 

Some researchers have suggested that personality traits and how a person relates to others cause people to deal with emotions in a certain way.

People who have maladaptive ways of relating due to personality traits born of early life experiences often do not respond well to medications. The truth is that everyone wants to connect to others and feel accepted. And when you have a hard time with this due to what was learned unconsciously (no fault of your own, of course), it’s natural to become depressed, anxious, and sick. Unfortunately, in these situations, medications may not offer enough. It’s like putting a bandage on a gushing wound.

Hopefully, by now you are gaining a greater appreciation of how we humans work! And I emphasize, WE humans! Correcting one’s way of relating to oneself and to others and helping them experience avoided emotions deeply can reduce depression.

How Can Psychotherapy Treat TRD?

There are various treatments for TRD once antidepressant medications are found to not to work adequately.

These include Ketamine, Lithium treatment, antipsychotic medications, Electro-convulsive Therapy, Trans-Magnetic Cranial Stimulation MS, and Intensive Short-Term Dynamic Psychotherapy.

Yes, I said psychotherapy!

Clients sometimes ask something along the lines of, “How can going to talk to someone really treat my depression? I was told that I have a chemical imbalance. Shouldn’t that be treated medically?” It really is a good and fair question to ask.

The first thing I would say is that effective psychotherapy involves way more than just talking. It involves the whole person (mind, emotions, body, and even the spirit) – from the client as well as the therapist! This may sound simple, but it is not necessarily easy. And it requires a lot of training and deliberate practice from the therapist.

The second thing I would say is that what causes depression and how it should be treated is a bit more complex than it may seem.

Let’s be honest… What most people know about depression comes from commercials and pop culture. Pharmaceutical companies are in the business of selling a product, as well as making effective medications. They do both well. And often, to sell well requires oversimplifying the message.

Depression Therapy: Frequently Asked Questions

The symptoms of are the same as with clinical depression. These include low mood, poor sleep, low energy, low self esteem, weight gain or loss, cognitive difficulties, social withdrawal, and suicidal ideation. What makes different from clinical depression is that it has often been treated in the past (either with medication and/or therapy) without lasting resolution. This is often a hallmark of treatment resistant depression. If you are in this situation where your medication and/or therapy hasn’t resolved your depression symptoms, you’re likely dealing with treatment resistant depression and I can help you find relief from that when we work together.

Depression can be effectively treated through psychotherapy. As to whether it can be cured “for good” is a different question. There is no guarantee that even when you are effectively treated for depression that it will not return, especially when you consider that for many people depression is situational. Loss, grief, and life changes can all bring on depression.

Statistically, having one depressive episode also increases your chance of having another in the future. With each episode, your chances of having another depressive episode increases there after.

To resolve these challenges with as much permanence as possible, you want to address your whole life. Lifestyle changes, such as eating healthy, exercise, getting good sleep, and managing stress will all have a positive impact on reducing your chances of experiencing a future depressive episode.

In psychotherapy, the symptoms of depression can be addressed fairly rapidly. Of course, it depends on your unique situation, lifestyle and circumstances. But, in general, I expect my patients to experience a significant relief from depressive symptoms within the first four sessions. If this is not happening, we typically have a conversation about the therapy and what may not be working.

Those who have a personality disorder along with their depression should expect it to take longer for depressive symptoms to remit. But the truth is, everyone has their own journey towards recovering from their depressive symptoms and we measure your results individually so as to get a fair look at the depth of your symptoms and your feelings of relief.

Depression Therapy FAQs

What are symptoms of treatment resistant depression (TRD)? The symptoms of TRD are the same as with clinical depression. These include low mood, poor sleep, low energy, low self esteem, weight gain or loss, cognitive difficulties, social withdrawal, and suicidal ideation. What makes TRD different from clinical depression is that it has often been treated in the past (either with medication and/or therapy) without lasting resolution. This is often a hallmark of TRD. If you are in this situation where your medication and/or therapy hasn’t resolved your depression symptoms, you’re likely dealing with TRD and I can help you find relief from that when we work together.

Can I cure my depression?

Depression can be effectively treated through psychotherapy. As to whether it can be cured “for good” is a different question. There is no guarantee that even when you are effectively treated for depression that it will not return, especially when you consider that for many people depression is situational. Loss, grief, and life changes can all bring on depression. Statistically, having one depressive episode also increases your chance of having another in the future. With each episode, your chances of having another depressive episode increases there after. To resolve these challenges with as much permanence as possible, you want to address your whole life. Lifestyle changes, such as eating healthy, exercise, getting good sleep, and managing stress will all have a positive impact on reducing your chances of experiencing a future depressive episode.

How long does it take to start feeling some relief from my depressive symptoms?

In psychotherapy, the symptoms of depression can be addressed fairly rapidly. Of course, it depends on your unique situation, lifestyle and circumstances. But, in general, I expect my patients to experience a significant relief from depressive symptoms within the first four sessions. If this is not happening, we typically have a conversation about the therapy and what may not be working.

Those who have a personality disorder along with their depression should expect it to take longer for depressive symptoms to remit. But the truth is, everyone has their own journey towards recovering from their depressive symptoms and we measure your results individually so as to get a fair look at the depth of your symptoms and your feelings of relief.

Get In Touch With Me

If you’re ready for this kind of support, I would welcome the opportunity to work with you. My services are cash-based and I am accepting clients now.

My office is in Annapolis, MD and you can reach me for a consultation by calling (410) 562-9647 or sending me an email at mail@annapolispsychotherapy.com