When one has a Major Depressive episode, outcomes of the greatest interest to medical intervention for both psychiatrists and patients are response, remission, recovery, relapse, and recurrence. Response is viewed as the very first treatment goal: is the patient’s depression magnified or minimized? This includes the diminishment of depressive traits, return to some level of stability, and the duration of the relief from baneful symptoms. The length of MDD episodes is globally unpredictable, as each person responds differently to medication and/or therapy. Therefore, it is essential to view “remission” in several ways: “full remission,” when there is the absence of the horrid symptoms of depression (lasting more than two months); and “partial remission,” when the intensity of depression falls, and/or the period of remission lasts less than two months. The term “relapse” refers to a recurrence of full MDD qualities following a response to medical intervention but before recovery is met; and finally, “recurrence” is used when a return to depression comes about after a period of recovery. It is perhaps this last part that makes MDD such a danger condition, especially for those who suffer from recurrent and severe Major Depressive qualities.
When remission is not reached through serious (and more than two) therapeutic and medical intervention, the patient may be declared “chemical” or “treatment” resistant. For these individuals, including the author of this article, this condition often illuminates a secondary health issue. For example, the patient may suffer from comorbid substance abuse or other mental health disabilities; problems with metabolism; and some of the time, noncompliance with treatment (i.e., missing many scheduled appointments or refusing/neglecting to take ones medication). It is imperative behavior health professionals determine the most likely cause (or causes) gently but quickly, for the rates of suicidal ideation (and even completed suicides) is extremely prevalent for individuals who are chemical resistant. There is disagreement whether switching the patient to another medication before augmenting the current antidepressant with another drug (i.e., wash out periods [usually two weeks] which may require hospitalization, dependent on the condition of the sufferer), wherein an in-class change may be well-tolerated but not as effective as a cross-class one. still Respectively, when the current antidepressant has shown positive signs of remission, an additional medication (most often an antipsychotic or mood stabilizer) may be used instead. This second drug can more specifically target the symptoms and side effects. In instances where this fails or is not an option, the patient may be advised to try ECT (electroconvulsive therapy), Vagus nerve stimulation (VNS), or Transcranial magnetic stimulation (TNS).
In addition to finding the appropriate medication cocktail, regularly attending therapy (be it interpersonal psychotherapy, psychodynamic treatment, CBT, or DBT), and trying to maintain or create as healthy a lifestyle as possible are imperatives. Over time, this has proven to help those suffering from chemical resistant depression in demonstrative ways, even though it can require hospitalization based on the severity of suicidal ideation. Patients can also attempt to help themselves by getting regular exercise, managing stress as best as they can, establishing good sleep hygiene, and ceasing the use of alcohol or other drugs.
It takes time, but there is indeed hope. Traditionally treatment resistant individuals must not settle for partially effective solutions when there is true hope for recovery—even if it takes a lot longer than desired.
Hold on. It gets better. It does.