In one out of four patients the treatments do not seem to give positive results, the causes may be biological or “environmental”, but it can also depend on the incorrect intake of medicines. Help from psychotherapy
One in four people with depression do not respond adequately to treatment, and in many cases this is the sign of one resistence which can also be confirmed with subsequent treatments. It is the so-called “resistant” depression, the one that has the most marked impact on the quality of life, on the state of general health and on health and social structures. Although there is no standardized definition, this term usually refers to forms of major depression who have not responded to at least two courses of antidepressant treatment. In fact, after these first two cyclesany subsequent courses with antidepressant drugs have a much lower probability of success, reflecting the fact that these are forms that are somewhat resistant to drugs.
The doses
A “pseudo-resistant” form of depression has also been identified: these are cases in which the lack of an adequate response is only apparent, because in reality it depends on the fact that they have been used drug doses incorrect or that the patient has not taken antidepressants or has done so inconsistently or for too short periods. A major depressive state may prove to be resistant to treatment also in relation to some inter-current life situations, such as bereavement, demanding physical illnesses, emotional losses, job loss, serious economic difficulties, important family conflicts. It is as if objectively difficult to overcome difficulties interpose themselves between treatment and recovery. According to Michael Thase and Kevin Ryan Connolly of the Mood and Anxiety Disorders Treatment and Research Program in Philadelphia, authors of the UpToDate chapter on resistant depression, there may be a specific profile behind this condition. genetic, functional abnormalities in some brain areas or neural networks, as indicated by some functional magnetic resonance imaging (fMRI) or positron emission tomography studies, or an increase in some specific biological markers of inflammation. However, a definitive answer does not exist at the moment, so that this condition remains not fully understood. The good news is that with specific repeated treatments, in about three out of four cases you can eventually get the better of a depression that initially manifests itself as resistant.
The strategies
The main strategies currently used for the treatment of resistant depression are to try different antidepressant drugs than those that have not been shown to work, or to resort to psychotherapies for which good efficacy has already been demonstrated, such as that with a cognitive-behavioral or interpersonal orientation. Another strategy widely used today is the addition of a second drug, while also keeping the current one. Lithium is mainly used – which also has a protective action against the risk of suicide – or so-called “atypical” antipsychotics, for example olanzapine or quetiapine. Also in this strategy, the addition of psychotherapy can become an important tool for reinforcing the efficacy of the drug, which in the first instance had proved to be insufficient. To give greater impetus to an antidepressant treatment that is struggling to achieve the goal, there are also further actions that can be taken, such as adequately informing the depressed person and his family about the characteristics of the disorder, its symptoms, its prognosis, but above all the cognitive traps that can make negative thoughts about yourself and your environment prevail as well as expectations. Adequate sleep hygiene is also important, as insomnia and early awakenings are disturbing symptoms and almost always present in depressed people. The quality of the doctor-patient relationship is fundamental. “Patients need to be encouraged,” say Michael Thase and Kevin Ryan Connolly. “They must be reassured that they will not be abandoned and that the doctor will do everything to help them get better.”
February 19, 2022 (change February 19, 2022 | 19:00)
© Time.News