Treatment for Treatment-Resistant Depression
June 1, 2018 5:18 AM   Subscribe

I have had Treatment-Resistant Depression most of my life and have tried many treatments without any relief. Details inside.

I've tried 25 medications, electroconvulsive therapy, ketamine infusions, and psychotherapy without success. I really need something to work because I don't know how to live with this anymore; the symptoms are overwhelming. Are there any options (besides TMS) that I haven't tried available?
posted by Four-Eyed Girl to Health & Fitness (20 answers total) 21 users marked this as a favorite
I don’t have TRD but have had severe depression and have been on meds since 15. Recently, my psychiatrist asked me if I wanted to get genetic testing to see what it might show as far as medications for me. She was pretty enthusiastic about it and since the max out-of-pocket would be $300, I felt that I could do it.

To say I was surprised by the results is an understatement. For every drug I took in the past that presented side-effects it marked me as high risk. For every drug which worse off, it pinpointed that. It also pinpointed my propensity for anxiety and long-lasting response to stress.

I don’t know if it’ll help you. Ask your psychiatrist.
posted by tcv at 5:29 AM on June 1, 2018 [13 favorites]

You mention psychotherapy. There are several different approaches, such as Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), Somatic Experiencing (SE), EMDR, and likely more.

If you haven't used a trauma-informed approach (EMDR and SE are), maybe you can look into them.
posted by Stewriffic at 6:04 AM on June 1, 2018 [4 favorites]

ALSO! I'm sure you have done this as well, but if not, it's worth investigating other medical issues that might be having an additive effect could help. The one that comes to mind (because it is my situation!) is sleep disorders.
posted by Stewriffic at 6:06 AM on June 1, 2018 [5 favorites]

Have you had a genetic panel? My mother who has same was found to have an issue which meant she didn’t take up folate. Look into Deplin.
posted by Riverine at 6:15 AM on June 1, 2018 [1 favorite]

Is there any trauma in your background that you haven't processed/explored? I had what looked like treatment-resistant depression for years and it's increasingly morphing into complex PTSD symptoms the older I get; treating the underlying trauma history seems to be going better than treating the depression as depression ever did.

I'm also of the belief that experiencing years of treatment-resistant depression is itself a form of trauma, so there might be stuff to explore from that angle even if you can't point to pre-depression traumas.

Also if you tend to think along the lines of "well my childhood wasn't amazing but it wasn't terrible", emotional neglect/abuse can be insidious and it's really common for people to minimise their own experience. I find this high-level list of children's needs (from this book) helpful whenever I'm tempted to minimise my own experience because it wasn't "as bad" as other people's or whatever:

Verbal nurturance: Eager participation in multidimensional conversation. Generous amounts of praise and positive feedback. Willingness to entertain all questions. Teaching, reading stories, providing resources for ongoing verbal development.

Spiritual nurturance: Seeing and reflecting back to the child his or her essential worth, basic goodness and loving nature. Engendering experiences of joy, fun, and love to maintain the child’s innate sense that life is a gift. Spiritual or philosophical guidance to help the child integrate painful aspects of life. Nurturing the child’s creative self-expression. Frequent exposure to nature.

Emotional nurturance: Meeting the child consistently with caring, regard and interest. Welcoming and valuing the child’s full emotional expression. Modeling non-abusive expression of emotions. Teaching safe ways to release anger that do not hurt the child or others. Generous amounts of love, warmth, tenderness, and compassion. Honoring tears as a way of releasing hurt. Being a safe refuge. Humor.

Physical nurturance: Affection and protection. Healthy diet and sleep schedule. Teaching habits of grooming, discipline, and responsibility. Helping the child develop hobbies, outside interests, and own sense of personal style. Helping the child balance rest, play, and work.

If any of that stuff was missing growing up, or if you identify non-childhood/non-family of origin traumas that could be contributing to your overall mental health, it might be worth looking into trauma therapy.

I realise I'm projecting wildly based on my own set of issues, and I know that it's entirely possible to have treatment-resistant depression that is just treatment-resistant depression and not a symptom of other stuff, so please disregard this if it doesn't resonate.

I only bring it up because I spent so many years ruminating on what I assumed was idiopathic (i.e. my fault for being inherently defective) depression. It was easier in some ways to experience the constant pain of depression-that-was-inherently-wrong-with-me than it was to even admit to the personhood-shattering idea that I was starved of all the good stuff kids need growing up. It's a lot less scary to believe you're fundamentally broken than it is to realise the child you used to be was badly failed by people who were supposed to care and protect.
posted by terretu at 6:28 AM on June 1, 2018 [25 favorites]

I think the above answers all ought to be visited first. But being diagnosed as very deficient in Vitamin D, actually because of another health problem, changed my life in terms of mental health.

With this in mind, I'd suggest adding "visit a nutritional therapist" to your to-do list, below the above points. Maybe it seems kind of niche? But I don't think it will, in the future. There are so many ways what we eat can affect us, and we're discovering new ones all the time.
posted by greenish at 6:41 AM on June 1, 2018 [4 favorites]

Perhaps consider seeking out participating in a study of hallucinogens for depression? The new Michael Pollen book discusses the promising recent research into this.
posted by latkes at 6:51 AM on June 1, 2018 [4 favorites]

Something to think about is whether you've tried all the different families of antidepressant (or of things-that-are-given-off-label-for-depression).

Like, 25 is a lot, and I'd be discouraged at that point too — but if it turns out, say, that none of those 25 has been a MAOI, or that none of those 25 has been an atypical antipsychotic, then that gives you something still to try in addition to the other good suggestions you're getting here.
posted by nebulawindphone at 6:57 AM on June 1, 2018 [4 favorites]

It is possible to have deep brain stimulation (DBS) for depression. This is obviously a major commitment (brain surgery!) and I'm not sure if it's offered outside of clinical trials yet (I worked in this area 10 years ago), but you could Google around. If you've truly had adequate trials of everything you've mentioned above, you may be a potential candidate.
posted by Bebo at 7:08 AM on June 1, 2018

My husband is in your situation, although he is bipolar so care has to be taken that he not push over into a manic state. He's currently doing the transcranial magnetic stimulation and has seen mixed results with it. Along with that he did the genetic testing that tcv mentioned. Due to the testing they are amending his meds so we're seeing where that takes us.
posted by PussKillian at 7:15 AM on June 1, 2018

There is some evidence that long-term psychoanalytic psychotherapy can be effective for those who have not had success with other treatments. Apologies if you have already tried this, best of luck to you.
posted by sometamegazelle at 8:17 AM on June 1, 2018

Like, 25 is a lot, and I'd be discouraged at that point too — but if it turns out, say, that none of those 25 has been a MAOI, or that none of those 25 has been an atypical antipsychotic, then that gives you something still to try in addition to the other good suggestions you're getting here.

stimulants are also used for depression sometimes. nobody will recommend them as a first choice and if they help it might only be temporary relief. but if they're not among the things you've tried, it's a possibility.
posted by queenofbithynia at 9:31 AM on June 1, 2018 [4 favorites]

IANAD. There have been studies like this one that suggest that liothyronine (t3 thyroid hormone) may be helpful as an augmentation to SSRIs in treatment resistant depression (who are not necessarily hypothyroid.) Anecdotally, I have seen it help a friend.
If that isn’t one of your 25, consider asking your psychiatrist if you might be a candidate for such an approach. Absolutely do not attempt to “try it out” without your Dr’s supervision (and blood work monitoring)—you can damage your thyroid if the dosage is not tailored to you and your needs.
posted by DB Cooper at 10:08 AM on June 1, 2018

I'm sorry. This is very hard to deal with.
I had decades of severe depression and was on multiple medications for at least ten years. I considered ECT, but I was scared off by the experience of my roommate in the hospital when I was being evaluated for it - her short term memory loss seemed unmanageable for me as a single mom. Somatic experiencing ended the nightmare for me. It wasn't an instant fix, but I got better after a few months and was eventually able to stop all psychiatric medication. It's been almost ten years since I've taken anything for depression or anxiety. I have what I consider normal mood fluctuations. I get somewhat depressed periodically, but it's nothing like what it was.

Some people report improvement by switching to a whole foods, vegan diet, but it's very hard to change your food when you're depressed. (You might already eat a great diet - I don't know - but food does affect the way you feel, so I'm just throwing that out there since you are having such a hard time.)

Best of luck to you.
posted by FencingGal at 2:38 PM on June 1, 2018 [1 favorite]

There seems to be new evidence that taking some kinds of antibiotics can lead to depression. They say it disrupts the gut bacteria and harms the way brain cells communicate.

Just as anecdotal evidence, I had multiple courses of antibiotics, trying to fix a chest infection and I became quite depressed. I also had stomach issues and in the course of trying to cure that, took huge doses of probiotics.

It’s only on looking back on the whole thing that I realise the probiotics also reversed the depression. Now obviously, there are lots of causes behind depression but if you have taken antibiotics in the past and any of this resonates, and are trying everything else anyway, taking some courses of varied good quality probiotics certainly can’t hurt and may do you some good.
posted by Jubey at 4:27 PM on June 1, 2018

I'm so sorry you're going through this, and want to suggest a few things:

1 Diet. I went through a period of severe depression, which morphed into an eating disorder. It was only after entering eating disorder treatment and eating balanced nutritional meals for the first time in years that my depression finally shifted. I'm obviously not suggesting you have an eating disorder, but a dietitian can make sure you're eating the right amounts of healthy fat, protein and carbs to make your brain chemistry happy.

2 Medical problems. Have you had a full medical work up? Thryroid, vitamin D deficiency, blood sugar wonkiness, and a whole host of other things can be contributing to depression.

3 Are there actually situational factors that could be impacting on you? Bad jobs, bad friends, bad family? Can you make life changes? Are you living in an area that just isn't right for you?

I'd also like to echo what Stewriffic said:

You mention psychotherapy. There are several different approaches, such as Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), Somatic Experiencing (SE), EMDR, and likely more.

Just like medications, each form of therapy seems to work for some people and not for others.

I'm not a medical professional but I do strongly believe there is no such thing as an incurable mental illness. You're obviously very strong to have made it this far.
posted by daybeforetheday at 3:02 AM on June 2, 2018 [1 favorite]

You don't mention light therapy or any kind of chronotherapy. Highly recommend this plus vitamin D plus high quality fish oil supplements. And don't settle for just 30 minutes a day under the light box if it's not working. It might take two hours (but be careful and monitor yourself at first).
posted by luckdragon at 5:35 PM on June 3, 2018

Heard this on NPR on my way to work this morning and thought of you.
posted by mareli at 6:20 AM on June 4, 2018 [2 favorites]

I've heard about 5-HTP mentioned. Assuming you had bilateral rather than unilateral ECT, since the former has a higher success rate if more memory side effects.

+1ing needing to know what those 25 medications were and in what combination - have MAOIs/ TCAs all been exhausted? Adjunctive medications? AAPs as mentioned upthread, and mood stabilizers as well. If overwhelming symptoms means suicidality, lithium has some evidence showing it to be particularly effective at reducing those cognitions. (n = 1 lifesaver for me).
posted by ahundredjarsofsky at 12:19 AM on June 5, 2018

Response by poster: Thanks so much for all of the answers!

Here are a few answers of my own:
I had bilateral and unilateral ECT.

I'll be getting the genetic testing next week.

I'm looking into DBS right now.

I had 13 years of all kinds of psychotherapy; all was focused on depression, not PTSD (which it seems I do have).

I have taken probiotics and Vitamin D for a while now. I have also taken lithium for an extended period of time.
posted by Four-Eyed Girl at 10:20 AM on June 7, 2018

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