Defining Treatment Resistant Depression: Its causes, and treatments

Depression is a brain illness in which the pathways which control mood are not functioning well; these areas are depressed in their functioning. These brain pathways, the neurons (brain cells), are not working as they once were. Depression has many origins, but the outcomes (symptoms) that most people with depression feel and show to others are similar. The symptoms of depression are: a depressed mood defined by sadness, guilt, lack of pleasure and disinterest, low energy and inactivity, low motivation, difficulty with thinking and concentrating, appetite and weight disturbance, feelings of hopelessness, helplessness, and sometimes thoughts of death and dying and unfortunately even suicide. These symptoms do cause terrible individual suffering. Many cases of depression are complicated because they are also associated with anxiety, physical illness, or pain (emotional or physical). Often the illness is accompanied by anxious, fearful, obsessive, ruminative, or even nihilistic thoughts.

In rare cases, depression can become even worse and individuals can experience very distorted thoughts called delusions, and/or auditory or visual disturbances called hallucinations. If your depression is characterized by these severe symptoms, please inform your treatment team as there may be better, and potentially quicker options for your care.

There is a significant lack of education in the world concerning depression and therefore, there is a large amount of stigma associated with the illness. Depression is not caused by poor motivation; it does not occur because the person did not try hard enough, did not read enough motivational books, or did not pray, meditate, or exercise enough. People do not cause depression to occur to them, but the illness does affect them significantly. Unfortunately, many people are uninformed and uneducated about depression which can strengthen the stigma of the illness.

Depression is an illness that does not discriminate based on race, gender, or socioeconomic status; anyone can get depression. Statistical studies show between 8-12% of people in the United States will meet the diagnosis of depression during any given year. Depression is presently the most disabling illness according to the World Health Organization. For those that have suffered with depression it is felt as a “dark hole”, “an abyss”, “a gray veil over life experiences.”

Diagnosing depression can be difficult, but with a professional evaluation, objective and subjective tests, and by excluding other medical illnesses, depression can be identified and treated. Over the last few decades, scientists have been able to develop tools to visualize the depressed brain and compare it those individuals that do not suffer from depression. In fact, Major Depressive Disorder (MDD), as an illness, is appropriately named; MDD is characterized by dysfunctional ‘depressed’ processing and communication among areas of the brain which we call networks. The important networks in the brain which are involved in depression include the dorsolateral prefrontal cortex, the anterior cingulate, the hippocampus, and the amygdala. At times, some of these areas are ‘depressed’ in their functioning and other areas may be overactive.

Depression is a brain disease that has genetic, biologic, psychological, social and spiritual causes, and, more often than not, the illness is multifactorial, meaning that many causes come together to give rise to the ultimate symptoms. Clinicians treat depression many ways; multifactorial illnesses get multifactorial treatments. Most treatments are biological (medications), psychological, social, and spiritual-cultural-mindful interventions to help patients who suffer get well.

When multiple medications fail to bring resolution of the illness, we call it treatment resistant depression. For those who have suffered with treatment resistant depression, surviving the day-to-day struggles with the illness is tough. Most individuals seeking TMS treatments have been living with treatment resistant depression.

Most individuals who read utilize this website will have a fairly good understanding of treatment resistant depression because they have suffered with the illness for too long. Although repetitive transcranial magnetic stimulation (TMS) treatment is not just for treatment resistant depression, often those people who seek repetitive TMS treatment for their care have had an aggressive, persistent form of depression. TMS is indicated for the treatment of Major Depressive Disorder and can be used at any point in the illness course. Economic studies have shown that TMS treatment is a cost-effective treatment after one medication fails to get a patient to remission.

In this website, you will make note of your clinician’s plan for your treatment. By addressing all potential areas to optimize your treatment, we believe you can get well. Clinicians refer to this wellness as remission. Most people understand the word remission when it pertains to cancer. When doctor help cancer patients get to a cancer-free place, they call it remission. Cancer can recur, but doctors know that treating cancer to remission can help prevent recurrence. Depression is frequently a recurrent illness like cancer, and clinicians have known for decades that if we can get a patient to remission, the patient is less likely to have a recurrent depressive episode. Combining many treatments is the current strategy to help ensure that patients get into remission and maintain remission from depression.

This website and its modules aim to help you, and your treatment team, to combine multiple strategies to aid your TMS treatment of depression.

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