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Posted by PaulB on July 29, 2001, at 16:24:30

In reply to TREATMENT RESISTANT DEPRESSION - INFO NEEDED, posted by sweetmarie on July 29, 2001, at 4:18:21

> I am a UK `visitor` to this site.
> I belong to an organisation called `Fellowship of Depressives Anonymous` (FDA), which is a charity run by and for sufferers of depressive disorders (and their carers).
> As a sufferer of so-called Treatment Resistant depression, I am hoping to put together an article about this condition for submission in the Newsletter. I`ve been meaning to do this for a few months now, but have been too ill and haven`t got round to doing it. An article in the last Newsletter has decided me to finally write this article.
> The article is about the Vagus Nerve Stimulator, and it`s success for people with treatment resistant depression. I am aware of this treatment, and do not dispute it`s usefulness in the treatment of sufferers like myself (and would certainly not rule it out for my own treatment if it were appropriate).
> The aspect of the article which I am seeking to dispute is the assertion that a certain percentage of sufferers can not be helped AT ALL by medications - "As many as 30% of those affected fail to respond to either drugs or ... electro-convulsive therapy". The article ends by pointing out that the Vagus Nerve Stimulator is effective for 40% of those who try it, which leaves "...about 10 - 15% of patients with depression who respond to absolutely nothing."
> I am currently being treated at a specialist unit for patients with Treatment Resistant depression. Whilst the unit is careful to say that there are `no guarantees` that a medication (or combination of medications) or other form of treatment will `work`, the medical professionals - in particular the professor who is in charge of my treatment - are convinced that help can be found for ALL sufferers (which obviously includes the use of the Vagus Nerve Stimulator). For this reason, the professor prefers to refer to this condition as `difficult to treat` depression rather than `treatment resistant` depression, a term which suggests that NO treatment will ever be found.
> It has been my experience that there IS a medication/combination of medications/other treatment options (VNS, ECT etc.) for everyone. As a sufferer of TR depression, I have done much research into the condition. By this I mean that I`ve read books, articles, spoken to other sufferers, trawled the Net and spoken with psychiatric proffessionals. The result of this has been that depression CAN be treated, but the uncertainty centres around `What?` (treatment) and `When?` (will this be found).
> What I am looking for is input from fellow Dr Bob web-goers on this condition. Specifically:-
> * Those who have proved difficult to treat, and their understanding of their condition;
> * What medical professionals have said;
> * Information gained from other `difficult to treat` sufferers (possibly from being in hospital/support groups etc.)
> * Information gained from literature/articles/internet research. I`d be particularly interested in any websites.
> I am going to approach my professor for a `quote` on the subject when I go back to hospital (tomorrow) so that I can include it. Meanwhile, ANY info would be TOTALLY gratefully received.
> Thank you so much for reading this incredibly long post. I hope you can help.
> Ta,
> Anna.
> p.s. Obviously, I also want to hear from those who have been told that they are `hopeless cases`, and about who exactly has told them that. I could be completely wrong, and there are those of us who are `hopeless cases`, but this is not what I have gathered, and - more importantly - I refuse to accept it and admit defeat.


I had a thorough read through your post and the responses it has received because it interested me. You seem to have done a lot of research and Im not sure anything I say will be new to you other than my own persoanl experiences but I hope I can help you.

I am from the UK too and have gone through the NHS for treatment of depression and anxiety.
On first going to your GP in the UK I believe it is common practise for him/her to prescribe an SSRI. If the person does not respond then the GP can maximise the dose. When I relapsed on Paroxetine and did not respond to an increase in dose up to 40 mg I was switched to Venlafaxine. I responded but then relapsed again.

At this point my GP considered me treatment-resistant and made a referal for me to see an NHS psychiatrist. As a GP I guess it wasnt his job to treat a person, like me who obviously needed specialist care and also he couldnt prescribe some of the drugs I thought were options at this stage-Moclobemide(Manerix) and l-Tryptophan(Optimax) . He mentioned that he thought treatment-resistant depression is serious because the success rate of treatment becomes lower after a patient has relapsed.

If I were writing an article about treamtnet-resistant depression I would consider the followiing factors to be worthy of criteria for determining a treatment-resistant case:
-Unresponsive/relapse on SSRI and after an increase in dose of SSRI
-Further non responsive/relapse on a dual acting antidepressant-TCA, Venlafaxine, Mirtazapine
or/and MAOI.
-Non response to psychotherapy alone, or in combination with antidepressant treatment
-Further non response/relapse when given augmentation strategies to potentiate antidepressants-Pinodol, lithium, tryptophan, atypical antipsychotics
-Unresponsive to ECT or VNS

As you have trawled the internet Im sure you have come across Dr Ivans Depression Central which contain new, good information on VNS as well as treatment-resistant depression:

As for going about getting treatment for treatment-resistant depression in the UK I got the impression after I saw the NHS psychiatrist that it was out of the NHS's hands. If I wanted help then I had to see a private psychiatrist. The NHS psychiatrist was very limited in his options available to me-'we could try another SSRI'. I got the impression that he had many patients to see on the NHS.

Good luck with the article




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