Treatment-resistant depression is a leading reason patients seek antidepressant alternatives, but it is far from the only reason. Though typically a first-line treatment, antidepressants are not the only option and are not right for every patient. The following are some reasons these drugs may not work for you and alternative therapies a psychiatrist might recommend.
In addition to the highly prescribed SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin and norepinephrine reuptake inhibitors), psychiatrists may consider a wide array of antidepressants. Though the options are many, antidepressants are either not right or do not work for a significant number of patients. Here is a closer look at some of the chief reasons.
John Hopkins Medicine reports that 30% of people with major depressive disorder (MDD) suffer from what is known as treatment-resistant depression (TRD). When the number of those with other forms of depression is included, this number could be higher. Patients with TRD do not get sufficient relief from traditional treatments such as antidepressants.
Despite the wide array of different antidepressant medications, finding one without side effects or drug interactions is highly unlikely. Many antidepressants are known for unpleasant side effects such as sexual dysfunction, sleep disturbances, and weight gain. Though many report these side effects improving with time or becoming tolerable, this is not always the case. Those with certain conditions, such as epilepsy, or who have negative interactions with other medications may be ineligible to take a vast majority.
Medications can impact pregnancy and fetal development. There are several antidepressants that professionals do not recommend during pregnancy. In addition, though some are considered safe, long-term evidence may be lacking. For peace of mind, many expectant parents would rather play it safe and look to antidepressant alternatives.
Some people wish to avoid taking antidepressants for personal reasons. These could involve anything from religious reasons to personal discomfort with taking psychoactive medication. Others want to make sure they try all their drug-free options before turning to a medication they will need to take daily.
Psychiatry and the mental health care system are continually seeking to improve upon the treatment of depression. The FDA has recently approved several treatments; others are on the horizon. Some of these antidepressant alternatives have been around for years, while others are newer. Here is a quick look at some key options when antidepressants do not work.
TMS is a form of brain stimulation showing promise in the treatment of a number of mental health disorders. Currently, it is FDA-approved for the treatment of treatment-resistant depression but may be an option for those who cannot take antidepressants. TMS uses magnetic pulses to effect changes in the parts of the brain associated with depressive symptoms.
This treatment is non-invasive and associated with little discomfort. Patients report few side effects and little to no downtime. TMS is not right for everyone, and those with certain medical devices and psychiatric and neurological conditions may not be candidates.
This antidepressant alternative is reserved for the most severe cases that have not responded to other treatments. ECT involves sending an electrical current through the brain to cause a seizure. The goal is to stimulate the release of neurotransmitters to alleviate symptoms. The psychiatrist will place the patient under general anesthesia during the procedure. This therapy carries a risk of possible adverse effects, including memory loss. Also, the FDA has not approved this treatment for children between 11 and 18, older adults, pregnant people, and those with a cardiovascular condition.
Ketamine therapy comes in two forms. One is an FDA-approved nasal spray derived from ketamine for the treatment of TRD. Ketamine via IV infusion is another option for off-label use to treat depression. Ketamine is thought to help increase certain chemicals in the brain to relieve depression symptoms.
Though mainly a treatment for TRD, a psychiatrist may recommend it for other patients at their discretion. Ketamine was originally used in anesthesia and now involves the psychiatrist delivering much smaller amounts for depression. The drug also has side effects to consider and must be administered by a licensed psychiatrist. Ketamine has been used for recreational purposes and is not for those with substance use disorder (SUD).
Psychotherapy or talk therapy is often used in addition to medication or one of the antidepressant alternatives listed above. Perhaps the most significant benefit of this option is that it is free of medical risks and side effects. The psychiatrist can conduct talk therapy using several methods, such as behavioral therapies that help patients examine their thoughts, feelings, and behaviors and replace negative or untrue patterns with positive ones. The two most important aspects of psychotherapy are finding the right therapist and a patient's willingness to participate.
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