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Dr. Bryan BrunoMedical Director · Mid City TMSPsychiatrist on Managing Treatment-Resistant Depression
My psychiatry practice focuses on treatment-resistant depression. We find that for many patients who have struggled to find an antidepressant medication that provides adequate relief, transcranial magnetic stimulation (TMS) can be life-changing. This FDA-approved treatment can painlessly and relatively quickly provide relief that patients have not found elsewhere. This treatment involves 20-40 minute sessions, usually five times a week for about five weeks, and involves magnetic pulses generating electrical currents in low-activity areas of the patient’s brain associated with depression. The patient does not feel these currents, but they increase activity in these brain areas and improve the patient’s symptoms and quality of life.
We have also found Spravato (esketamine nasal spray) to be a highly effective treatment for many patients with treatment-resistant depression, sometimes even on the first visit. After receiving the nasal spray, patients stay for a two-hour observation period. Typically, three sessions of treatment will be enough to evaluate whether the treatment is effective. If so, the patient will continue receiving treatment twice a week for four weeks, and then once a week for the following four weeks. Patients may also choose periodic maintenance sessions after that.
Written by Dr. Bryan Bruno, Medical Director at Mid City TMS. Mid City TMS is a New York City-based medical center focused on treating depression.
Name: Dr. Bryan Bruno
Company: Mid City TMS
Designation: Medical Director
Website: https://www.midcitytms.com/
Headshot: https://imgur.com/Iq9QW5U
Rebbeca Lahann, Psy.D.Psychologist and AASECT Certified Sex Therapist · Spectrum Psychology and WellnessOne effective technique for managing treatment-resistant depression in Cognitive Behavioral Therapy (CBT) is Behavioral Activation (BA). This approach focuses on the individual's behaviors and aims to increase engagement in rewarding or fulfilling activities.
The premise of BA is to identify and gradually reintroduce activities that bring a sense of accomplishment, pleasure, or satisfaction. Often, in depression, individuals withdraw from activities they once enjoyed, which further exacerbates their symptoms. By scheduling and participating in these activities, even in small steps, individuals can experience a positive shift in mood and motivation.
Working collaboratively, I would encourage setting achievable goals, breaking them down into small, manageable steps, and gradually increasing the level of engagement in these activities. Additionally, monitoring mood changes before and after engaging in these activities helps individuals recognize the connection between their behaviors and emotions, fostering a sense of control and empowerment in managing their depression.
However, it's crucial to approach treatment-resistant depression with a personalized and multifaceted strategy. This might involve combining CBT techniques with medication or exploring underlying factors contributing to the resistance to treatment, all tailored to the individual's unique needs.
Tanveer PadderPsychiatrist · Psychopharmacologist, Addiction SpeacalistOne thing that has been very helpful in treating treatment-resistant depression (TRD) is combining a serotonin-norepinephrine reuptake inhibitor (SNRI) with a stimulant and a low-dose antipsychotic. SNRIs, such as venlafaxine or duloxetine, work by increasing the levels of serotonin and norepinephrine in the brain. Adding a stimulant, like methylphenidate or modafinil, can augment the antidepressant effect. Stimulants may enhance energy, concentration, and motivation, addressing aspects of depression that SNRIs alone might not fully alleviate.
Electroconvulsive therapy, often referred to as ECT, is a medical procedure that may provide relief when other depression treatments haven't been effective. It involves a brief electrical stimulation of the brain while the patient is under anesthesia. This therapy has a history of success in alleviating severe depression, especially when symptoms persist despite medication and therapy.
Research has shown that it can cause changes in brain chemistry that can rapidly reverse symptoms of depression. If you're considering alternative treatments for persistent depression, consult a specialist about the potential benefits of ECT.
Ketamine infusions are emerging as a promising option for individuals facing depression that has not improved with standard treatments. Unlike traditional antidepressants that can take weeks to work, ketamine works quickly, often within hours or days. The treatment involves administering small doses of ketamine, a drug known for its rapid mood-enhancing effects, under medical supervision.
Its unique mechanism affects neurotransmitters in the brain, providing fast-acting relief. Speak with a healthcare provider to learn more about the potential of ketamine infusions for treatment-resistant depression.
Vagus nerve stimulation (VNS) is an innovative approach to treating treatment-resistant depression. This technique involves a surgical procedure where a device is implanted in the chest to send regular, mild pulses of electrical energy to the brain via the vagus nerve. Researchers believe this helps to stabilize mood over time.
While VNS is generally reserved for severe cases of depression, it represents a hopeful avenue for those seeking alternatives after conventional methods haven't worked. If you or someone you know struggles with persistent depression, VNS might be a conversation to have with your doctor.
Transcranial magnetic stimulation (TMS) is a non-invasive therapy that can be effective for those who haven't found relief from depression through traditional methods. It uses magnetic fields to stimulate nerve cells in the region of the brain involved in mood control and depression. The treatment is typically administered over several weeks and does not require anesthesia.
It’s an FDA-approved option that has shown to be beneficial for many people with depression. Explore the possibility of TMS as a treatment by seeking further information from a healthcare professional.
Psychedelic-assisted psychotherapy is a novel approach that incorporates psychedelics, such as psilocybin, with psychotherapy to treat depression. This combination aims to facilitate deeply introspective experiences that can help break the cycle of depressive thoughts and behaviors. The controlled setting and the guidance of a trained therapist are intended to help individuals gain new insights and perspectives on their mental health.
Although it is still being researched, this method has shown promising results for some people. If traditional treatments haven’t worked for you, discuss with a mental health professional whether psychedelic-assisted psychotherapy could be an appropriate treatment option.
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