What Is Treatment Resistant Depression?

Frequently I am asked what is treatment resistant depression?

First let’s define depression. Depression in many people’s minds is someone curled up in a fetal position in the dark, crying. But this is not at all the typical presentation of depression. Depression is an illness characterized by some of the following:

 Feeling sad or low

Having an "empty" mood

Feeling anxious

Feeling guilty or helpless

Feeling worthless, hopeless, or pessimistic

Feeling restless, frustrated, or irritated

Losing interest in things you once enjoyed

Avoiding your usual activities

Having less energy and feeling fatigued

Moving or speaking slowly

Having difficulty paying attention, remembering, or making decisions

Having difficulty sleeping, waking up too early, or oversleeping

Experiencing unplanned changes in eating habits and weight

Experiencing headaches, cramps, digestive issues, or other aches and pains that don’t have a clear cause and don’t get better with treatment

Talking about death, having thoughts of suicide, or attempting self-harm

 Once a Major depression has been diagnosed, if it does not respond to treatment by at least two different antidepressant medications.  

In general, the standard for treating depression is to start by treating with a Selective Serotonin Reuptake Inhibitor (SSRI), if a patient does not respond to one of these, the provider will likely trial another type of antidepressant that may target different neurotransmitters in the brain such as epinephrine, dopamine or Gamma-aminobutyric acid which is commonly referred to as “GABA”

 If an individual is not responsive to at least 2 traditional antidepressants, there are other options that become available. Recently an inhaled form of Ketamine known as esketamine which goes by the brand name of Spravato, has become available to treat these individuals. Treatment with Spravato has very few limitations on its use. The two biggest limitations from the prescriber side is that the patients’ blood pressure must be less than 140/90, with or without treatment and they cannot have any current or past history or treatment of an aneurysm.

Individuals that are treated with Spravato are given a series of doses of the medication in a monitored setting over the course of 8 weeks. Each treatment episode requires a 2-to-2.5-hour commitment of time to allow for administration of the inhaled medication and monitoring of.

In addition to the use ability to use Spravato, there is also a novel treatment that is available called “TMS” or Transcranial Magnetic Stimulation.

Demystifying Psychiatry for the Church – Part 2

How does the Christian church view mental illness?

Isn’t the joy of the Lord supposed to be our strength?

How can we sing about peace and joy and at the same time be drowning in sorrow and fear?

Often we find ourselves saying, “Just surrender it to God.” Yet mental illness is not something we can just pray away.

The prevailing culture of silence, along with misguided attitudes and erroneous expectations, often causes suffering believers to feel shamed, blamed, and unsupported. Individuals frequently end up isolated and rejected They cannot share the burden they carry and they fear the stigma of a mental illness diagnosis.

As believers, we tend to frame everything in the context of spiritual issues or demonic manifestations. Perhaps we need to build a framework of understanding how the biology of the brain operates.

Why are we in the church fearful of medication?

If we have gastrointestinal upset, difficulty breathing, or sudden dizziness, we seek medical help to determine the cause of the problem. If our brain is having trouble functioning, why would we not go to the doctor?

Clearly there is a need for the mental health community to build a dialogue with Christian leaders and vice versa.

There are many factors that impact mental health – environment, GMO foods, pollution, living longer, 24-hour news cycle, trauma, broken homes, war, bullying, video games content, and substance abuse are some of the obvious.

Medications

In the 1960’-70’s psychiatry shifted the psychoanalysis focus on free association and investigating conflict between Id, Ego and Super Ego to a focus on biological science. There were significant discoveries of medications to help those who suffered from “insanity” or psychosis.

We learned that the primary chemicals in the brain which affect mood, focus, energy, and perception were a balance of norepinephrine, serotonin, dopamine, and GABA. These are the 4 primary targets of medication management today.

In 1960’s we had veterans of the Korean conflict who had returned home with battle fatigue or shell shock – a malady that impaired the individuals’ ability to emerge from the horrors of war. Later, in the Vietnam era, it was more aptly named Post-Traumatic Stress Disorder (PTSD) which is descriptive of the root cause of the dis-ease

By bringing mental illness out of the shadows of the church, offering acceptance and support, creating a community of understanding and encouragement, individuals will be more open to seeking the treatment needed to stabilize their mental health. Once stabilized, the healing work can begin by addressing past trauma, childhood wounds, or faulty belief systems. Studies have shown that pairing psychotherapy with medication has the quickest recovery and the greatest success when treating mental illness.

Blog Post Title Three

It all begins with an idea. Maybe you want to launch a business. Maybe you want to turn a hobby into something more. Or maybe you have a creative project to share with the world. Whatever it is, the way you tell your story online can make all the difference.

Don’t worry about sounding professional. Sound like you. There are over 1.5 billion websites out there, but your story is what’s going to separate this one from the rest. If you read the words back and don’t hear your own voice in your head, that’s a good sign you still have more work to do.

Be clear, be confident and don’t overthink it. The beauty of your story is that it’s going to continue to evolve and your site can evolve with it. Your goal should be to make it feel right for right now. Later will take care of itself. It always does.

Blog Post Title Four

It all begins with an idea. Maybe you want to launch a business. Maybe you want to turn a hobby into something more. Or maybe you have a creative project to share with the world. Whatever it is, the way you tell your story online can make all the difference.

Don’t worry about sounding professional. Sound like you. There are over 1.5 billion websites out there, but your story is what’s going to separate this one from the rest. If you read the words back and don’t hear your own voice in your head, that’s a good sign you still have more work to do.

Be clear, be confident and don’t overthink it. The beauty of your story is that it’s going to continue to evolve and your site can evolve with it. Your goal should be to make it feel right for right now. Later will take care of itself. It always does.