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Nancy Schimelpfening

Options for Treatment-Resistant Depression

By March 10, 2009

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Have you been through numerous drug trials without getting relief from your depression? Do antidepressants only work for a short while before "pooping out"? Treatment-resistant depression (TRD) can be very discouraging for those who have it, but there are options that may be able to help you.

One option is electroconvulsive therapy (ECT). While ECT doesn't come without side-effects, it does bring rapid relief for about 80 percent of patients and it can work where other treatments have failed.

A newer option is vagus nerve stimulation (VNS), which involves the implantation of a pacemaker-like device to periodically send a pulse to the vagus nerve, which communicates with brain cells involved in mood control.

If medications have failed you, please don't give up hope. Speak with your doctor about other treatment options available to you, such as ECT and VNS.

Comments
April 30, 2008 at 9:45 am
(1) Jim says:

Thank you for finally stating the fact that treatment resistant depression exists. I have had major depression for the last 25 years. For a while medication worked, but then it “pooped out” as you say. I went for years where all I did was try every possible combination of drugs without any luck. I am puzzled why your column never lists psychoanalysis as an option. True, it is very expensive, but it is the only thing that has brought me relief. I feel that it is purposely not talked about because professionals would then have to deal with clients that see an option, but is out of their reach causing more problems. The fact is that many analysts will work with the patient on finances and analysts-in-training will often do it for next to nothing. I believe that this is often the reason that nobody talks about “TRD” again, professionals are concerned that patients will give up hope if medication does not work. Thank you very much for bringing to light two more options that few doctors will every recommend.

Sincerely,

Jim

April 30, 2008 at 11:10 am
(2) Chris says:

I had ECT when I was 18 and it worked excellent. I also had it when I was 35 and it made things worse. It affected my memory so much it affected my job; I could not function. I could not remember simple things like relatives names’, simple recipes, my phone number, forgetting what I was saying mid-sentence, getting lost in a town where I grew up and lived my whole life, spelling words (which I never had a problem with), vocabulary and just plain English. To this day, I still struggle. It is a little better but I still have memory issues. It has left me feeling as though my IQ is back to elementary level.

If you do decide this route, go to a good place like a University, that is where I went when I was 18.

April 30, 2008 at 5:18 pm
(3) Sheri says:

Hi,
I was 22 and gave my Dr an ultimatum. Have a series of blood studies and if they showed depression, then I wanted ECT. No more “we can try this” without effect. Well the Dexamethasone Suppression test and Thyroid tests were way off. I was a slug with no motivation or want to go thru another day. I was lucky the tests pointed my Dr to an Endocrinologist who sent me to a surgeon for a tumor on my adrenal gland. I had no problems with depression after surgery until recently. That was 26 yrs ago. It saved my life as I had started muscle wasting.
I found then how many people who are depressed have medical problems that either are the culprit or aggravate the illness. It is very important for anyone with any form of depression to get a thorough medical evaluation which includes the Dexamethasone Suppression test and other labwork. There are medical problems that can be fixed and it will take the depression with it.
No more assuming that it is emotional. Most Dr’s have to be reminded to look further. Not just medicate.
Thank you,
Sheri

May 1, 2008 at 10:37 pm
(4) Annie says:

ECT does pose a risk of side effects and complications, such as memory loss and confusion.

But now the procedure has become refined, with precisely calculated electrical currents administered in a controlled medical setting to achieve the most benefits with the fewest risks.

March 11, 2009 at 4:54 pm
(5) Patricia says:

I have had Treatment Resistant Depression for about 10-15 years. I have been on multiple anti-depressants which work for awhile but then stop working. Right now I am on a MAOI wich was my doctor’s last resort. I have opted not to have ECT because I am a single parent and I have to work to support my family. With no support system to help ECT was not a viable option for me. I have fought for 2 years with my insurance company through appeals to have VNS to no avail. They continue to refuse to allow it even though I fit the FDA requirements for VNS therapy. My doctor doesn’t know what to do when the medication I am on runs it course and no longer works. I have run out of options for treatment and I am very disgusted that insurance companies get to decide what treatment patient’s will get.

November 17, 2011 at 9:58 am
(6) San says:

Hello,
I too suffer from treatment resistant depression and I am about to start ECT as I have no other course of action. I am curious as to why your insurance company will not cover VNS if you meet all the FDA requirements. Is that legal? I know that fighting them (suing etc.) isn’t necessarily an option as it requires money and time but I just wonder what their reason for rejecting your claim is. I am not trying to be negative but I am worried that ECT may not work for me. My hopes are that it will but I am also being realistic and prepared for the possibility that is may not. If this is the case it worries me that my options will be “out” since I cannot afford to pay for other treatment out of pocket. I would appreciate any info you may be able to share and I do hope things improve for you! It’s a difficult struggle and I wish you the best.

March 12, 2009 at 12:26 am
(7) shalinie says:

my mom has taken 5 different medicines + homeopathy for past year.we have reached a status quo after that.how many more drugs should we try till we choose ECT.

March 18, 2009 at 7:11 am
(8) kim says:

mine was an emergency case as it was acute and meds haven’t started working; then years later i had a relapse which needed ECT agn… memory sure’s affected as Chris mentioned- both long term and short term ones; scary

May 30, 2009 at 8:19 am
(9) JANE says:

Do NOT EVER have ECT. It erases your short term memory and the good effects of the treatment are very short lived but you are stuck with the memory loss forever! I have told my shrink that if he ever mentions it to me again I will pick up my pocketbook and leave never to return & I’ve been seeing him for 15 years.

November 9, 2009 at 3:54 pm
(10) Patrick says:

I’ve had treatment resistant depression since I was 15 years old. I am now 29 turning 30. In June 09, I received the VNS implant surgery and the implant has been turned up very high after not working in the lower settings. It’s now November 09 and it is still not working. Because of a recent tragedy I lost my insurance, girlfriend, job, and place to live. I know they say that it can take up to a year for the VNS impant to work, but I don’t have a year, so I am considering having ECT, and hopefully that will help my VNS implant start to work.

March 8, 2011 at 2:36 pm
(11) Chris says:

Just thought I would tell you what I experienced with the VNS implant that I had implanted two years ago. For me, it was a nightmare. I actually became so desperate to remove it that I ended up removing it myself (insurance would not pay to remove it). Of course, I would not have done that if I wasn’t a surgery tech and knew pretty much what I was doing. I also checked myself into the hospital right after removing it. If you would like to know more about my situation, you can email me at chrislangeph@yahoo.com.

Chris

December 6, 2009 at 8:06 am
(12) max says:

Nothing works, 40 plus drug trials, ECT, MAIO, and dozens of alternative therapys and methods of group and single thearapy for almost 30 years now. Its brutal emotional waterboarding and relentless. I’ve lost my marriage and every good significant relationship since, as every single job and there have been many and good ones. i’m in financial ruin, no assets, dependent on a 86 year old mother I can’t stand for support. My daughter has witnessed my anguish and interrutpions first hand. She loves me dearly is my brightest om scholarship in college in Paris. She told me that she and her siblings will be sad if I commit suicide but not hurt, and would comepletely understand. She is sending me a tome’ on painless fail-safe self-euthenasia. It is the greatest, most selfless act of love from a chlld to a parent I’ve ever known. I will put it to good use with that love for her also.

December 6, 2009 at 8:11 am
(13) max says:

Nothing works, 40 plus drug trials, ECT, MAIO, and countless alternative therapies and methods of group and single thearapy for almost 30 years now. Its brutal emotional waterboarding and relentless. I’ve lost my marriage and every good significant relationship since, as every single job and there have been many and good ones. i’m in financial ruin, no assets, dependent on a 86 year old mother I can’t stand for support. My daughter has witnessed my anguish and interrutpions first hand. She loves me dearly is my brightest om scholarship in college in Paris. She told me that she and her siblings will be sad if I commit suicide but not hurt, and would comepletely understand. She is sending me a tome’ on painless fail-safe self-euthenasia. It is the greatest, most selfless act of love from a child to a parent I’ve ever known. I will put it to good use with that love for her also.

January 8, 2010 at 2:33 pm
(14) Margaret says:

I’ve tried about twenty-five drugs, alone or in combinations. There have been anti-depressants, anti-psychotics, amphetimines, tranquilizers, mood stabilizers and drugs I don’t know how to categorize. The best I can say about any of these drugs is that they have taken away my anger. This is no small thing, because it has saved my marriage and my relationships with my children. But I still feel like crap. Every day I want to die. I made an almost successful suicide attempt four years ago, but I promised my children I would not do it again. Now I hope for a terminal illness, because I believe that would nullify my promise to my children.
As for ECT, I would not recommend it for anyone. There is no guarantee that it will help, but the side effects are forever. It has left me with severe cognitive impairment, which caused me to lose my job. So, not only do I feel worthless and depressed, I feel stupid and poor as well.

November 23, 2010 at 2:22 pm
(15) Nicole says:

ECT is AWFUL. I gave in and had ECT when my medications failed over and over again. I now have severe memory loss that makes my depression WORSE than before. Still have not found any treatment that works and my psychiatrist tells me I have “taken everything” medication-wise. All I can say is that ECT is so NOT worth it.

December 25, 2013 at 9:40 am
(16) Shelli Castanos says:

Like so many of you, I have been struggling with TRD since I was an adolescent and have been on more than 30+ different medications. I tried bio-feedback, hypnosis, psychotherapy and still nothing relieved this awful hopeless feeling. Then a psychiatrist who also is involved with research tried me on Adderall. It was as if my entire world started to glow and I was alive again. I take 30 mg two times a day. The problem now is I moved away from the Doc who was prescribing the Adderall and am seeing psychiatrists within a County Mental Health System. NONE of them will continue treating me with Adderall. Why? Because it does not fit within their parameters of treating depression. But it WORKS!! What ever happened to the saying – “Treat the patient and not the illness?” Also, my insurance will not pay for the medication because it does not fit within their formulary for depression. What the heck is the matter with these idiots? Have they never heard of PRACTICING medicine? I am going to have to sell some of my personal items so I can see a psychiatrist in private practice. They have no problems in prescribing me Adderall. Now, if they were to report ADHD as a secondary illness, my insurance would then cover the medication and TOO, the County minions would agree to prescribe me the only medication that makes my life worth living!!
Good luck to all of you and Happy New Year!!

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