Treatment-resistant depression and emerging treatments
Join our Clinical Director, Dr. Iain Jordan, as he provides a comprehensive overview of Treatment-Resistant Depression (TRD), delving into discussions on current treatments and unveiling the cutting-edge clinical research underway at Clerkenwell Health.
Depression (or major depressive disorder) is a common and often debilitating cluster of symptoms which can cause a great deal of suffering. Treatment-resistant depression (TRD) is a term used to describe depression that has not substantially improved despite treatment. It is a term of debatable utility, as there is an implicit assumption that it describes some characteristic of the condition itself, rather than reflecting the fact that currently available treatment options are often inadequate. But it is a term in common usage which you may come across – especially in the world of research and clinical trials. Up to 60% of patients with depression have an inadequate response to treatment so TRD is common. TRD does not necessarily mean that the depression is more severe, just that it hasn’t responded enough to treatment.
Why is it ‘Treatment-Resistant’?
Depression may not improve with treatment for a variety of reasons. As mentioned, the treatments which patients currently have access to are not effective for everyone. Depression of any kind often has a complex set of causes and influences, which vary from person to person, and treatments in psychiatry are rarely personalised - so it is very likely that people are receiving treatments that do not specifically target their underlying causes. Finally, some people have problems that are more complex or ‘stuck’ than others and may need more complex interventions – for example, a combination of behavioral and lifestyle interventions, psychological treatments, and medication. Like all mental health diagnoses, those with TRD often fulfill criteria for at least one other diagnosis – such as anxiety disorders, trauma-related disorders, and diagnoses across the neurodiversity spectrum.
Below you will find information on current treatment approaches and research into TRD (including psychedelic medicines, which is our specialty) as well as information about upcoming trials we are running for this indication.
Current treatments and research for Treatment-Resistant Depression
Psychotherapy:
Psychotherapy is effective for TRD, though as with all groups, a particular patient may respond better to one type of therapy than another. Commonly employed therapies include cognitive behavioral therapy, mindfulness-based therapy, acceptance and commitment therapy, and dialectical behavioral therapy.
Treatment augmentation refers to the addition of a medication (such as lithium or thyroid hormone to antidepressant medication. Alternatives to antidepressants, such as antipsychotic medications are also sometimes used. Where there is more than one diagnosis, treatment may also need to be tailored – for example, trauma-focused care where there is a history of traumatic experience.
Increasingly treatments such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) are becoming available and are being trialled in the NHS. For those with severe and highly treatment treatment-resistant depression, more invasive treatments such as deep brain stimulation are sometimes used.
Personalised Interventions:
Tailoring treatment plans to an individual's particular causes, genetic makeup, lifestyle, and specific symptoms is likely to become realistic in the coming years though research into these approaches has yet to yield promising results.
Novel Drug Treatments:
such as ketamine and medications that target inflammation in the body and brain hold promise for alternative treatments. Ketamine is a useful option for some patients.
Psychedelic Treatments:
There are some preliminary studies suggesting that psychedelic medicines (usually combined with therapy) may be effective for some people with depression and treatment-resistant depression. Medicines under investigation include psilocybin (found in magic mushrooms), DMT, and 5-MeO-DMT. As with all such research, we are some ways from knowing for sure, which is why continued, high-quality research studies are so vital.
Clinical Research at Clerkenwell Health
We are currently recruiting for clinical trials for many different diagnoses – including treatment-resistant depression.
In clinical trials, treatment-resistant depression typically refers to inadequate response to at least two medications in the current episode. If you think that you, or anyone you know, may fit this description, or are interested in any of our clinical trials of psychedelic medicines and psychedelic-assisted psychotherapy, click the link below.
Our commitment to pioneering research, ethical practices and individual well-being defines our approach to mental health care. With your help, we can uncover new possibilities, challenge old paradigms, and contribute to the global search for better mental health care.