A Pep Talk for Those With Treatment-Resistant Depression


A Pep Talk for Those With Treatment-Resistant DepressionIn his book, Understanding Depression: What We Know And What You Can Do About It, J. Raymond DePaulo Jr., M.D. asserts that for the 20 percent of his patients who are more difficult to treat, or “treatment-resistant,” he sets an 80 percent improvement, 80 percent of the time goal. And he usually accomplishes that.

Now, if you’re not someone who has struggled with chronic depression, those stats won’t warrant a happy dance.

But if you’re someone like myself, who assesses her mood before her eyes are open in the morning, hoping to God that the crippling anxiety isn’t there, then those numbers will have you singing Hallelujah.

They are better than the statistics released by a large, six-year, four-step government study called the Sequenced Treatment Alternatives to Relieve Depression trial, or STAR*D. STAR*D looked at the use of popular antidepressants in people with chronic, severe depression who do not respond to a particular drug and may suffer from multiple mental and physical disorders.

The researchers found that trying treatment options such as adding a second drug to a SSRI, switching to a new drug or a different class of drug, and waiting a full 12 weeks to assess results can lead to remission in symptoms in up to half of patients.

That’s not much to celebrate, in my opinion. Good news, but not great.

Folks trudging through the everyday muck of depression and pervasive, annoying, destructive, negative, intrusive thoughts need hope. Lots of it. Daily. Hourly. I know I did. And still do.

In March 2006, I had just finished trying the 23rd combination of mood stabilizers and antidepressants and I still wanted to die. That’s not to mention all the psychotherapy, mindful meditation, light therapy, rigorous exercise, yoga, fish oil, and other techniques I was trying. When my doctor threw out DePaulo’s numbers I did not believe them. However, about two months later, under her care, I was miraculously able to experience a day without any death thoughts. Nada.

The last 18 months have been somewhat of a rerun. I never fully recovered from a crash in August 2011, despite my wholehearted attempts at mindfulness and different kinds of therapy, 10 or so medication combinations, intense exercise, light therapy, diet changes and supplements. Some days were better than others, but I didn’t go much longer than 15 seconds without fighting a death thought. This ongoing silent battle inside my noggin made it very difficult to accomplish anything other than my necessary responsibilities, let alone open space in my life to have fun.

During the last few months, just as in 2006, I have been running dangerously low on hope.

In fact, I began to research transcranial magnetic stimulation, a procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. That and electroconvulsive therapy are the last-ditch efforts for those of us checking off double digits of medication combinations and every kind of alternative therapy out there. I was even mapping out my schedule as to how I would spend my morning for two and half months at Johns Hopkins Hospital and how I would explain this to my manager at work.

“Before we go there, let’s try one more combination,” my doctor recommended.

Sure. Yeah. Whatever. Like that’s going to make a difference.

I was wrong. It took the 11th or 14th, or whatever number combination it is, to give my tired brain a respite from the death dialogue, and the stamina I needed to push me into the real world again … so that I can practice mindful meditation in a way that doesn’t make me feel demoralized, or swim in the morning without having to hold back tears, or pursue a passion such as reaching out to those with depression — all of which are important facets to my recovery.

The 80-in-80 aren’t exactly statistics that you’ll hear promised in an ad for an antidepressant, but those numbers sure are chock-full of hope for this depressive. I hope they are for you too, and encourage you to keep on keeping on until you can keep on without quite as much effort.

Published originally on PsychCentral.com

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Therese Borchard
I am a writer and chaplain trying to live a simple life in Annapolis, Maryland.

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