Keep fighting even when depression treatments don't work

This blog has sensitized me to how hard it is for so many of you with severe depression to find help. National Suicide Prevention Lifeline
1-800-273-TALK (8255) Go to the nearest hospital or emergency roomCall your physician, health provider or clergyNational Alliance on Mental Illness
www.nami.org
1-800-950-NAMI (6264)It's very clear that there's a wide range of severity of symptoms. Perhaps more importantly, there are wide variations in the responses you have to the currently available treatments.

If you begin to experience severe depression for the first time as a young adult, the prognosis is generally quite good. There's an almost 50 percent remission rate with the selection of the first medication — if it's taken properly and for a sufficient period of time. Ultimately, more than 80 percent of you will respond to one of the many available medications. However, the fact that some of you don't respond is a huge problem.

There's no simple solution for treatment resistant patients. Your best hope is to be persistent. However, it's difficult to be persistent when you're seriously depressed. It's a cruel "Catch 22."

Electroconvulsive therapy (ECT) is available for treatment resistant patients and many do respond to it. While there continues to be controversy about it, and there's no question that it can result in the loss of memory, ECT has saved the lives of many. Newer treatments, such as transcranial magnetic stimulation (TMS), offer hope. However, those who are resistant to medications may also be resistant to TMS.

Over the years, I've seen our treatments improve. I remember a world without serotonin transporter inhibitors. It was a world where our best drugs had considerable toxicity. It was also a time when we had fewer options if you were seriously depressed.

We treat thousands of people who have mood disorders. Clearly, most if them get better and many have a complete remission of their symptoms. However, it would be wrong to suggest that even in 2010 there's an effective treatment for everyone. Nevertheless, we're committed to finding new ways to try to help everyone.

There's no major medical specialty that has the ability to cure everyone they try to treat. Some people with asthma don't respond to even the newest asthma medications and have crippling wheezing which dramatically restricts their activity. Some people with diabetes can't control their glucose despite the huge advances in our understanding of the biological basis of diabetes. Perhaps most frustrating of all, many cancers continue to take the lives of our loved ones despite billions of dollars of medical research and the hard work of many medical professionals.

I don't want to suggest there's an easy answer for those of you who suffer from treatment resistant depression. However, I do want to underscore that many of you can improve with modern treatments. For those who don't, it's critical to maintain your determination to "fight the battle" even when it seems hopeless. Having friends, a family that cares, and a doctor you can trust are still among the most powerful weapons to fight depression.

blog index