Sometimes conventional treatments such as antidepressants and psychotherapy do not work for Depression. Can drugs be the solution?

The good news first: “Depression – even if it is persistent – is an easily treatable disease,” says Prof. Mazda Adli. He heads the research area affective disorders at the Berlin Charité.

So if the word “therapy-resistant” is mentioned in a conversation with the doctor, it does not mean that nothing can be done about the depression. In medicine, there is already talk of therapy-resistant depression when two different antidepressants in sufficient doses over a period of four to six weeks have not led to an improvement.

“It’s very important to make it clear that therapy-resistant doesn’t mean that you can’t be treated, but that the disease is simply persistent,” says Mazda Adli. And a stubborn course is not uncommon. According to Adli, around a third of patients with depression would initially not respond to two treatments with medication.

“The patients, their relatives, but also the doctors then need staying power and a lot of patience during the treatment.” But there are many ways to help people with depression, even if the first medication and perhaps the first attempt at psychotherapy didn’t work.

Treating depression: There is a clear step-by-step plan

If a depression does not improve with the tried and tested treatment methods, work is continued with a clearly regulated step-by-step plan and one looks beyond that until it gets better.

The guidelines for the drug and therapeutic treatment of depression state what options are available. These include electroconvulsive therapy (ECT) or repetitive transcranial magnetic stimulation (rTMS).

With ECT, a brief electrical stimulation of the brain triggers an epileptic seizure. With rTMS, on the other hand, nerve cells in some areas of the brain are stimulated from the outside with the help of a magnetic field.

Both methods of brain stimulation have been tried and tested. However, there is less evidence for rTMS, i.e. less scientific knowledge, that it can help with therapy-resistant depression. Therefore, so far only the ECT is reimbursed by the Statutory Health Insurance companies.

Ketamine as an emergency treatment

Andrea Jungaberle is an emergency doctor and anesthetist and researches the topic of expanding consciousness – also in the treatment of depression. She emphasizes that it is important not to leave the patient alone with the classification “therapy-resistant” and to look for further treatment options together.

Many – including Jungaberle – see new hope for the treatment of depression in substances that were previously known as drugs .

This includes esketamine. This is a form of ketamine that has long been used as an anesthetic and is known as the party drug “Special K”. In Germany , esketamine is now used as a nasal spray for the short-term emergency treatment of severe depression and the treatment of therapy-resistant depression.

No comparison with a drug self-experiment

Professor Gerhard Gründer from the Central Institute for Mental Health in Mannheim (ZI) is leading a study examining the antidepressant effects of psilocybin. This is an active ingredient from hallucinogenic mushrooms. At the ZI and the Charité Berlin, 144 patients with treatment-resistant depression are receiving this substance under supervision. Psychotherapists prepare the subjects for the experience and then work through what they have experienced in sessions.

Founder emphasizes that such a treatment cannot be compared to a drug self-experiment: “In Holland, psilocybin-containing truffles are legal and you can buy them in shops there. But it is by no means a treatment to take such a substance once. You have to prepare and follow up on this well in a treatment context.”

Mazda Adli also emphasizes that it is important to take such substances under medical supervision, as they could lead to a kind of alienation experience. “Some people experience dissociative experiences. After taking it, some have the feeling that they are floating through the room, that colors change or the intensity of noises. Some people don’t find it unpleasant at all, others do, and some people just notice it nothing.”

Gründer explains that clinical studies on these alternative treatment methods are initially only about possible approval. Only then would it be decided whether the statutory health insurance companies would cover the costs of the treatment.

Drugs are not the panacea

“You have to dampen the euphoria a bit,” says Gerhard Gründer. “In the media, at least in some articles, psychedelics are being praised as a panacea.” But there are already a lot of antidepressants that are available and effective. “But in the end, psychedelics are just a very useful and probably promising addition to our therapy options.”

Andrea Jungaberle observes that Germany is very late with its research in an international comparison. “It’s been going on in Switzerland much longer and there are also studies in Great Britain , Holland and the Czech Republic . Thank God Germany has now jumped on the bandwagon, but we’re about five to ten years behind.”

Mazda Adli also believes that innovations are needed in the treatment of depression. “We need new and further developments in antidepressants. Depression is a very common illness. A specific antidepressant does not work for everyone and, of course, treatability gains with the number of options available.”

Psychotherapy is always part of persistent depression. In addition , exercise , a balanced day/night rhythm and learning to behave in a self-care manner would support the treatment.

Source:uslifestyler

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