Approximately 10 percent of depressed persons are treatment resistant. These folks have not responded to antidepressants or any kind of medication. Their efforts at cognitive-behavioral therapy and other types of therapy have failed. Even sessions of electroconvulsive therapy (ECT) have proven unsuccessful. These people are the sickest of the sick, and spend their days in a kind of living hell which can’t be transformed simply by a new perspective, even as pop psychologists would like to believe.
Sometimes I wonder if I fall into this group. Since I spend my days writing tips for managing depression, I feel as though I should be fully recovered; however, the truth is that I haven’t managed to escape thoughts of death for longer than a few months at a time, even after substantial sessions of cognitive-behavioral therapy and employing other techniques. I live and cope continuously with mental angst—faking my way through the day as a competent worker, mother, and wife. I’m typically convinced I’m on the brink of a nervous breakdown, fragile enough that any unfortunate event might send me to the hospital again. Do other people feel like this? I don’t think so.
That is why I am hopeful when I read about brain-imaging research and the possibilities it presents for treating persons with severe and chronic depression—the kind that doesn’t go away after 10, 20, and 40 years, despite efforts at finding the right medication, therapy, diet, and exercise program. The studies also assure me that my depression isn’t about a rigorous attitude adjustment or a second entry in my gratitude journal. “Imaging research has confirmed that depression is, first and foremost, a brain disease,” writes Helen S. Mayberg, M.D., a renowned neurologist, in the Johns Hopkins Depression & Anxiety Bulletins.
So far pharmacologists and psychiatrists have concerned themselves mostly with the overall chemistry in the brain—the imbalances of neurotransmitters–without looking into the abnormalities in different regions of the brain, and the activities in those problem spots, that may be contributing to intractable depression. Now neurologists like Mayberg are using brain-mapping techniques to discover what occurs inside the brain and how those functions are connected to mood. The brain-imagining technologies have allowed scientists to look at the regional patterns of brain activity and determine how the specific circuits of the brain differ in persons who are depressed versus the “normal,” happy, annoying folks.
Mayberg encourages persons with treatment-resistant depression to believe in the future. She writes:
We are about to start an experiment to determine whether there are subtypes of depression we can identify to help us select optimal treatments. As in cardiology, you shouldn’t have to suffer from chest pain for 10 years before you have a coronary bypass procedure. Psychiatry is now beginning to realize that some people who don’t get better might not be nonresponsive to treatment because of their genes, for example….
This neurological perspective—focusing on specific brain circuits—differs from, but is complementary to, the biochemical approach of drug therapy, which affects the action of cells throughout the entire brain, regardless of what region they are in. A whole new approach for developing targeted treatments is now foreseeable….The goal to develop an imaging-based sets of rules to help determine which patients will respond best to which treatment—a means of optimizing treatment strategies for individuals, helping them to avoid the current trial-and-error approach.