Medication Resistant Depression and Anxiety

Wayne Health’s Psychiatry and Behavioral Health team has provided behavioral health services for children, adolescents and adults since 1995 using a “whole-person” approach to care.

Depression is no stranger to most. It is experienced by most people to some degree over the normal course of their lives and daily living. Depression is synonymous with sadness, feeling down-hearted, bummed out, or blue, with low energy. There are different degrees of depression, including mild, moderate and severe.  These degrees are ranked based on several factors that may include:

• How long a person experiences depressive feelings, thoughts and energy levels
• The degree to which a person’s life is impacted relative to family and friends
• Participation in meaningful activities, such as work or school

Depression is usually treated with a combination of antidepressant medication and certain types of therapy, including psychotherapy. For some, antidepressants provide relief without further interventions.

Depression that doesn’t respond to antidepressants is known as treatment-resistant depression. Anxiety that doesn’t respond to medication, counseling and lifestyle changes may be treatment resistant anxiety.

Depression and anxiety can affect people differently, and if ignored, can lead to more serious issues. So it is important to talk with your physician about your symptoms and options.

• Rapid-acting antidepressant medication administration

• Psychotherapy or other Cognitive Behavioral Therapies (CBT)
• Vagus Nerve Stimulation
• Electroconvulsive therapy

• Repetitive transcranial magnetic stimulation (rTMS)
• Transcranial direct current stimulation (tDCS)

What is anxiety?

Anxiety is a feeling of fear or concern that something bad may happen. Feeling worried or nervous is a normal part of life. Everyone feels anxious from time to time. Mild to moderate anxiety can help you focus your attention and energy.

But if you have severe anxiety, you may feel helpless or confused. You may worry about things that aren’t likely to happen. Severe anxiety is also called generalized anxiety disorder.

Anxiety disorder occurs when you feel worried and stressed about many things. This type of worry disrupts your life on most days. Many people with anxiety disorder have physical symptoms, such as headaches or being tired all the time.

Anyone can get an anxiety disorder at any age. But it often starts when you are a child or teenager. Women are twice as likely as men to have the problem

What do you need to know to prevent depression from coming back?

Know your risk of depression coming back

Many things can make a person more likely to have depression again. These include having depression symptoms that continue after treatment, a previous episode of depression, and a history of childhood abuse or neglect.

It is important to know your risk and to recognize warning signs of depression symptoms returning. Once you know these things, you will be better able to keep it from happening to you.

Know the warning signs of depression returning

The two most common signs of depression coming back are:

• Feeling sad or hopeless.
• Losing interest in your daily activities.

You may have other symptoms, such as:

• You eat more or less than usual.
• You sleep too much or not enough.
• You feel restless and unable to sit still.
• You feel unable to move.
• You feel tired all the time.
• You feel unworthy or guilty without an obvious reason.
• You have problems concentrating, remembering, or making decisions.
• You think often about death or suicide.
• You feel angry or have panic attacks

Wayne Health focuses on educating patients about the treatment options available to treat their depression and anxiety. We offer decision aids that address the needs of individuals with different styles of selecting treatment options. Our information packet describes the types of treatments and provides detailed information about potential issues and concerns associated with those treatments. We also provide a question and response brochure that will assist you in identifying the treatment options that best match your needs. These decision aids have been evaluated and modified based on feedback from individuals who are receiving treatment for depression.

Medicines

Antidepressant medicines may improve or completely relieve the symptoms of depression. Whether you need to take medicine depends on your symptoms. You and your doctor can decide if you need medicine and which medicine is right for you.

You may start to feel better within 1 to 3 weeks after you start taking antidepressant medicine. It can take as many as 6 to 8 weeks to see more improvement.

Counseling

Counseling and psychotherapy are important parts of treatment for depression. You will work with a mental health professional such as a psychologist, licensed professional counselor, clinical social worker, or psychiatrist. Together you will develop an action plan to treat your depression.

Lifestyle changes

You can do many things to help yourself when you feel depressed or are waiting for your medicine to work. These things include being active, getting enough sleep, and eating a balanced diet.

Other treatment

Other treatments for depression include:

• Brain stimulation. This includes:
  • Electroconvulsive therapy (ECT). Electrodes that produce a brief electrical stimulation to the brain are placed on the head. The stimulation produces a short seizure that is thought to balance brain chemicals.
  • Deep brain stimulation. A device that uses electricity to stimulate the brain is put in your head. It is used for Parkinson’s disease. But it has not been well studied for depression.
  • Vagus nerve stimulation. A generator the size of a pocket watch is placed in your chest. Wires go up from the generator to the vagus nerve in your neck. The generator sends tiny electric shocks through the vagus nerve to the brain.
  • Transcranial magnetic stimulation. An electromagnet is placed on your head. It sends magnetic pulses that stimulate your brain.
• Complementary therapies. Always tell your doctor if you are using any of these types of therapies. They include:
  • Massage therapy, yoga, and other relaxation exercises.
  • Fish oil containing omega-3 fatty acids.
  • SAM-e (S-adenosylmethionine).

How is generalized anxiety disorder treated?

Counseling and medicine can both work to treat anxiety. The two are often used along with lifestyle changes.

Cognitive-behavioral therapy (CBT) is a type of counseling that’s used to help treat anxiety. In CBT, you learn how to notice and replace thoughts that make you feel worried. It also can help you learn how to relax when you worry.

Medicines can help. These medicines are often also used for depression. Selective serotonin reuptake inhibitors (SSRIs) are often tried first. But there are other medicines that your doctor may use. You may need to try a few medicines to find one that works well.

Many people feel better by getting regular exercise, eating healthy meals, and getting good sleep. Mindfulness—focusing on things that happen in the present moment—also can help reduce your anxiety.

Wayne Health physicians and researchers are also teaching and research faculty at Wayne State University School of Medicine who conduct basic, translational and clinical research. This makes the latest treatments and clinical trials available to you sooner than other providers without a medical school affiliation, and often before FDA approval or commercial availability.

For more information, please visit the links below at the WSU School of Medicine.