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 illness,” says Prof. Mazda Adli. He heads the affective disorders research area at the Berlin Charité.
So if the word “therapy resistant” comes up in a conversation with your doctor, that doesn’t mean that nothing can be done to combat the depression. Medicine is already talking about treatment-resistant depression when two different antidepressants in sufficient doses over four to six weeks have not led to improvement.
“It is very important to make it clear that being resistant to treatment does not mean that you cannot be treated, but that the disease is simply stubborn,” says Mazda Adli. And a stubborn course is not at all rare. According to Adli, around a third of patients with depression would initially not respond to two treatments with medication.
“The patients, their relatives and also the doctors need perseverance and a lot of patience during the treatment.” However, there are many ways to help people with depression, even if the first medication and perhaps the first attempt at psychotherapy had not worked.
Treat depression: There is a clear step-by-step plan
If depression does not improve with the tried and tested treatment methods, we continue to work with a clearly regulated step-by-step plan and look beyond it until it gets better.
Guidelines for the medication and therapeutic treatment of depression state what options are available. These include electroconvulsive therapy (ECT) or repetitive transcranial magnetic stimulation (rTMS).
During 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 externally using 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 treatment-resistant depression. Therefore, so far only ECT has been reimbursed by statutory health insurance companies.
Ketamine as an emergency treatment
Andrea Jungaberle is an emergency physician and anesthesiologist and researches the topic of expanding consciousness – including 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 treating depression in substances that have previously been better 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 to 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 test subjects for the experience and then work through the experience in sessions.
The founder emphasizes that such a treatment cannot be compared to a drug self-experiment: “In Holland, truffles containing psilocybin are legal and you can buy them in the store there. But taking such a substance once is by no means a treatment. You have to prepare and follow up this well in a treatment context.”
Mazda Adli also emphasizes that it is important to take such substances under medical supervision, as they can lead to a kind of alienation experience. “Some people experience dissociative experiences. After taking it, some people have the feeling that they are floating through the room, that colors or the intensity of noises are changing. Some people don’t find this unpleasant at all, others do and some people simply notice it nothing.”
Founder explains that clinical studies on these alternative treatment methods are initially only about possible approval. Only then would a decision be made as to whether 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, psychedelics are praised – at least in some articles – as a panacea.” But there are already a lot of antidepressants that are available and effective. “But in the end, psychedelics are simply avery useful and probably promising addition to our therapy options.”