Medication Resistant Depression and Anxiety

Wayne Health’s Psychiatry and Behavioral Health team focuses on caring for the total health of patients and the community-at-large. We’ve been a dedicated provider of behavioral health services for children, adolescents and adults since 1995.

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

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

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 medication-resistant depression. Anxiety that doesn’t respond to medication, counseling and lifestyle changes may be medication- resistant anxiety.

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

Wayne Health offers leading-edge treatments for medication-resistant depression and anxiety, including rapid-acting antidepressant medications and repetitive transcranial magnetic stimulation (rTMS). Any patient can ask to receive a specialized evaluation for these treatments.

• Rapid-acting antidepressant medications
• Psychotherapy or other cognitive behavioral therapies (CBT)
• Repetitive transcranial magnetic stimulation (rTMS)
• Transcranial direct current stimulation (tDCS)
• Vagus nerve stimulation, by referral
• Electroconvulsive therapy, by referral

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 is dedicated to educating patients about the treatment options available to treat medication-resistant depression and anxiety. We offer decision making aids that address the needs of individuals with different styles of selecting treatment options. This includes an information packet that describes the types of treatments and provides information regarding potential issues and concerns associated with those treatments. We use a collaborative process with each patient, coming to a shared plan that meets each individual’s unique needs. No treatment for medication-resistant depression and anxiety is provided without written consent of the patient and, if necessary, guardians or other personal supporters.

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.

Physicians and researchers at Wayne Health are also faculty members of the Wayne State University School of Medicine who conduct research and clinical studies. This makes the latest treatments and clinical trials available to you sooner than other health providers without a medical school affiliation. We are fully committed to innovative research that advances care and treatment in behavioral health.

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