As a former sufferer of severe depression, I can help explain what it is like to experience the pain and misery that I and many others have gone through. Therefore, if you are living with treatment resistant depression, or want to learn more about it, then this page is going to be very helpful. In particular, I will focus on a topic I have been writing about for over 20 years, self esteem.
What are the options for living with treatment resistant depression? One option is Transcranial magnetic stimulation, or TMS. Any treatment must be discussed with a medical professional. Other options also help reduce low self esteem and lack of confidence. In this case, seeing a psychiatrist is very important.
When we talk about options though, there are many different things to consider and your path will be unique. Please consider the options below and think carefully which might be for you.
What does Treatment Resistant Depression Mean?
A person is treatment-resistant if they have tried an adequate dose of two different antidepressants for six weeks with no lessening of symptoms. This often leads to a person turning to alternative methods of treating depression. For those in this situation, consulting with a psychiatrist prior to trying new options is Extremely Important.
Options for Living with Treatment-Resistant Depression
As treatable as depression is today, there are those individuals for whom nothing seems to work completely. Taking an antidepressant may have helped some but failed to alleviate all symptoms, while others have improved temporarily only to have symptoms return at a later date.
There is, in fact, some disagreement about the effectiveness of antidepressants, as explained by Ioannidis in this article from the journal Philosophy, Ethics and Humanities in Medicine. He argues that many studies have tested relatively low numbers of patients and that often studies with negative results are ignored.
Up to one-third of adults who suffer major depression symptoms have what is known as treatment-resistant depression, or TRD (source:American Journal of Psychiatry) .
In addition to the above, 50%–66% of patients in the study do not recover fully from depression.
What are the Effects of Treatment Resistant Depression?
One of the symptoms of major depression is low self esteem and poor levels of confidence. In fact, depression and low self esteem seem often to go hand in hand as one feeds off the other. Therefore, in order to build self esteem and more confidence, overcoming depression is essential.
People who are living with treatment resistant depression are no different from other depression sufferers and self esteem levels can be very low. There are many other symptoms which can grow out of the negative feelings associated with low self esteem and which contribute to a poor quality of life. Some of these include regret, anger, victim mentality, lack of confidence, poor body image and many others discussed on this website.
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TRD patients have a poor level of life satisfaction according to this study in BMC Psychiatry. Whatever medical treatment the doctor prescribes, it also seems that other therapies that would help the patient to raise positive feelings and attitudes such as healthy self esteem and self confidence would be a good thing.
What is the effect on self esteem and Self Confidence?
When depression is difficult to treat, problems of confidence and self esteem as well as a lack of hope, indecisiveness and a lack of purpose or direction in life need to be dealt with. There are many strategies which are helpful, such as positive affirmations, gratitude journals and talk therapy among others.
There may be factors in a person’s life that contribute towards depression. This is why seeing a therapist is important and does offer hope.
Some people may have suffered from low self esteem and lack of motivation etc. for their whole lives. There is evidence, though, that those suffering from treatment resistant depression have significantly more negative thought related issues and than those who do not suffer from it.
Many psychotherapists do think that unresolved conflicts causing emotional problems and issues related to poor self worth and lack of self esteem can be treated effectively. This leads to the idea that the best form of treatment involves therapy plus medication (source: Journal of Psychotherapy Practice and Research)
What a Psychiatrist Can Do For You
A psychiatrist can assess all other treatments that have failed and rule out any other condition such as a thyroid condition, that might be causing symptoms or worsening them. They can help explore life situations that might be leading to depression and low self esteem. They can also discuss whether treatment recommendations are being followed and that medications are being taken in a prescribed manner. Most importantly, a psychiatrist can rule out other mental health conditions such as bipolar disorder, which would require a different treatment.
Recommending giving antidepressants more time to work, adding another antidepressant of a different class to affect a wider range of chemicals affecting mood, or even adding a medicine not specifically for depression are all strategies psychiatrists can use when a patient appears to be treatment-resistant. If all of these treatments fail, a psychiatrist may want to try procedural treatments such as TMS treatment.
Transcranial Magnetic Stimulation
Transcranial magnetic stimulation, or TMS, is a treatment approved by the American Psychiatric Association and cleared by the FDA. The treatment offered by Pulse TMS and similar institutions is a non-invasive option that does not require sedation. The patient remains awake during the procedure, which is administered by a machine generating highly concentrated magnetic pulses. This results in the stimulation of the prefrontal cortex in the brain and the connected areas. A series of these treatments have been shown to bring relief of major depression symptoms (source: Arch Gen Psychiatry).
Some of the advantages to TMS treatment include the ability of the patient to receive it in an outpatient setting and the ability to go about daily activities afterward as the treatment does not affect cognitive functioning or loss of memory. Another advantage of TMS is that although it can be administered alongside antidepressants as determined by a psychiatrist, it works equally well without. This works well for patients who experience adverse side effects of antidepressants.
Beginning with the psychiatrist in the initial session, the individual patient threshold for stimulation level is determined followed by the planning of treatment which is comprised of five treatments each week for a period of four to six weeks. Each of the standard treatments lasts between nineteen to thirty-seven and a half minutes each. Depending on the outcome of treatment, follow-up sessions may be planned.
Electroconvulsive therapy, or ECT, administers a measured dose of electricity to the brain. This triggers a small seizure, but the promising results make it a popular treatment for depression. The procedure reverses major symptoms of depression, but some patients are left with after-effects such as confusion or temporary memory loss.
Effectiveness of TMS
The treatment appears to be very successful, with low numbers dropping out as treatment continued. Side-effects are not known to be a problem as in other treatments including medication (source: Fitzgerald et al).
Mindfulness-based cognitive therapy
MBCT, or Mindfulness-based Cognitive Therapy combines CBT with mindfulness to effectively help treat depression and low self esteem. Mindfulness can be used to help people to build positive attitudes and removes negative thinking.
Mindfulness focuses on the present moment and helps encourage a way of living that is very different from the negative patterns of thinking which depression encourages and feeds off. Such things such as meditation can heighten awareness of the present moment and bring an inner peace to replace the inner chaos of depressive thinking.
Mindfulness is also helpful because it stops constant overthinking and racing thoughts. These often turn into worry for someone suffering from anxiety and depression.
Which Option is Best For You?
Which option is right for you? I can’t tell you. It will depend on your specific situation as well as the opinion of your psychiatrist. Therefore, if traditional options have failed, all suitable alternatives should be on the table.
So be brave, get help, seek advice and try because you are worth it. You deserve to get better. You deserve a happier and healthier life. Now, go get it!
- Ioannidis, J.P. Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials?. Philos Ethics Humanit Med 3, 14 (2008). https://doi.org/10.1186/1747-5341-3-14
- Rush, A. J., Trivedi, M. H., Wisniewski, S. R., Nierenberg, A. A., Stewart, J. W., Warden, D., … & McGrath, P. J. (2006). Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR* D report. American Journal of Psychiatry, 163(11), 1905-1917.
- Fitzgerald PB, Brown TL, Marston NAU, Daskalakis ZJ, de Castella A, Kulkarni J. Transcranial Magnetic Stimulation in the Treatment of Depression: A Double-blind, Placebo-Controlled Trial. Arch Gen Psychiatry. 2003;60(10):1002–1008. doi:10.1001/archpsyc.60.9.1002
- Jaffe, D.H., Rive, B. & Denee, T.R. The humanistic and economic burden of treatment-resistant depression in Europe: a cross-sectional study. BMC Psychiatry 19, 247 (2019). https://doi.org/10.1186/s12888-019-2222-4
Website Author and Editor Bio
Karl Perera is a fully qualified Life Coach (DipLC), Teacher (MA) and author of Self Esteem Secrets. He has taught at various universities including Durham, Leicester and Anglia Ruskin, Cambridge. He has run More-SelfEsteem.com since 1997 and is an expert in Self Esteem and Self Confidence.