Treatment resistant depression, or refractory depression, cases are so classified when patients are observed to show no response to several antidepressant treatment procedures and/or medication.
Simply put, they are instances where conventional methods of depression treatment do not work at all. In such cases, patients can be left feeling discouraged and hopeless. In extreme circumstance, they can suffer without any relief for months or even years. And all of it has a compound effect on the depression which already haunts them.
While scientists have not yet been able to discover a permanent solution for treatment resistant depression, there have at least been several advances to mitigate and manage its effects, especially in the field of medicine. The real difficulty presents itself when even those methods fail to work, and patients are left almost entirely without hope.
Further compounding the problem is the fact that treatment resistant depression can often be rather difficult to diagnose. There are other conditions and/or problems which can present similar symptoms. Even when diagnosed correctly, the treatment is not easy where it is at all possible. Patients have to explore a combination of avenues, such as taking medication on top of consulting with both a psychiatrist and a psychologist all at once.
Depression can present as one of many types. The major, or most common, ones include Persistent Depressive Disorder, Bipolar Disorder, Psychotic Depression, Atypical Depression, and Seasonal Affective Disorder (SAD).
Perhaps the most difficult aspect of combating depression is that patients can often regress even after they believe themselves to be cured, and returning cases can often prove to be worse than the original diagnosis.
To understand why this happens, and what can be the possible solution it, we must understand the causes of depression and why the current treatments might not be as effective as to provide permanent solutions.
Understanding the Symptoms
What most people do not understand is that there is no permanent cure for depression, yet. It is not entirely true that a person who has depression continuously stays in the state of being depressed. The person can be depressed at a certain point of time, and then be completely normal for years only to face another, possibly even worse, episode of depression.
The state of being depressed can be prolonged due to several factors but that does not mean it is permanent. With the help of proper treatment and assistance, treatment resistant depression can be controlled. No one can pinpoint the reason why a person goes through depression but the general factors include environmental, biological, and emotional. There are different stressors as well that can trigger an episode.
Through research, we have found that our mind and our body can store information and experiences, especially as muscle memory. Therefore, they often act subconsciously, and react to certain situations—and sometimes, to certain drugs. This is one of the major reasons why our brain stops reacting to medicines and drugs after repeated administration. It has increased its endurance against them, and built an immunity.
The process can make patients believe that the symptoms have worsened, even though in reality, they might be the same but may have just stopped reacting to the treatment. However, there is still a possibility that there might also be entirely new symptoms in addition to the ones already experienced.
Is There No Solution At All?
Treatment resistant depression (TRD) can be difficult to treat due to the very reason that it does not get affected by most medications or counseling. Scientists are finding new ways to alter the brain receptors or messengers that transmit positive chemicals and neurons throughout the body. One breakthrough in this aspect has been the clinical introduction of ketamine and its administration.
Regardless of the type of depression, even if it is treatment resistant depression, ketamine has proven to be successful in being an analgesic. What ketamine does is that it interferes with the neurons, and forces the brain to dissociate itself from the reality, forgetting the pain or trauma. Just because the brain separates itself from reality through this drug, it stops being in a depressive state.
Most importantly, ketamine does not work in the same way as conventional antidepressants usually given to patients for depression treatments. Instead, it works by blocking a receptor called N-methyl-D-aspartate, or NMDA. It also increases the amount of glutamate, which in turn activates the AMPA receptor. Together, these two actions help enhance the communication between the brain’s neurons and showing promise as a treatment for TRD.
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