Mainstay Treatments for Mental Health Conditions
Medications and therapy remain mainstay treatments in the management of mental health conditions and research prioritizes these methods as first-line treatment options for conditions like depression, anxiety, bipolar disorder, trauma, schizophrenia, addiction, and more.
For the vast majority of people with mental health conditions, medication, therapy, and lifestyle modification can provide adequate symptom relief. A subset of individuals may experience only partial improvement with these standard treatments and may be considered to have “treatment resistant” conditions such as treatment resistant depression.
Understanding Treatment-Resistant Depression
Research shows that approximately 30% of people with major depressive disorder suffer from treatment resistant depression, meaning they have tried a variety of medications combined with evidence-based therapy with limited improvement in their depressive symptoms.
In order to determine whether someone has treatment resistant depression, they will need to have a mental health evaluation with a psychiatric provider to ensure their condition has been appropriately diagnosed and that they have been treated with appropriate medications and/or therapy styles specific for their condition.
Medications generally can take up to 2 months to build up in your system before determining your response to a dose, so before saying a medication “doesn’t work”, you will want to be sure to work with your provider to reach an appropriate dose of your medication for an adequate amount of time for it to actually work.
Interventional Psychiatry
In cases of treatment-resistant depression there are options outside of standard medications and therapy. Within the field of psychiatry, there are a variety of treatments that have recently gained attention and popularity for the management of treatment resistant mental health conditions.
This field of psychiatry is referred to as Interventional Psychiatry and includes treatments such as transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT), intravenous (IV) ketamine infusions, esketamine (Spravato), psychedelics like MDMA, and more. Below we will highlight information about each of these treatments.
Transcranial Magnetic Stimulation (TMS)
Transcranial Magnetic Stimulation (TMS): TMS is an FDA-approved treatment for treatment resistant depression and major depressive disorder. TMS is commonly covered by insurance.
TMS works by delivering electromagnetic impulses to areas of the brain involved in depression and anxiety. TMS can be time consuming as it requires you to present to the clinic for treatment every day for 6-8 weeks, but treatments only last a couple of minutes long and require no down time on your part so you can carry on your day like normal.
People with implanted metal in the head, cochlear implants, and history of seizures may not be good candidates for TMS.
Electroconvulsive Therapy (ECT)
Electroconvulsive Therapy (ECT): ECT is a treatment used for severe depression, bipolar disorder, and psychosis. ECT is commonly delivered in the inpatient hospital setting but may be done in the outpatient setting on an intermittent basis.
ECT is conducted with the patient under anesthesia and with use of muscle relaxants so you are asleep for the treatment. During ECT, patients are delivered electrical stimulation to the brain which induces a mild seizure which creates changes in the brain to treat mental health conditions.
IV Ketamine Infusions
IV Ketamine Infusions: Ketamine is currently being used to treat a wide variety of conditions including depression, anxiety, post-traumatic stress disorder, and more, though the greatest evidence for ketamine is for its use in treatment resistant depression.
Ketamine is considered an “off-label” treatment for use in psychiatry, and therefore very few insurances cover ketamine, meaning you will likely have to pay out of pocket with infusions costing hundreds of dollars each. Ketamine is infused through an IV in your arm to induce rapid acting antidepressant effects.
During ketamine infusions, people experience a mild state of dissociation which may be described as feeling woozy, intoxicated, or disconnected from surroundings.
Ketamine requires a driver to treatment and people are often “out of it” for a couple of hours after their treatment Ketamine is generally avoided in people with unstable bipolar disorder, psychotic conditions, people with a history of brain bleeds, aneurysms, or significant cardiac history.
Esketamine (Spravato)
Esketamine (Spravato): Spravato is an FDA-approved medication for the treatment of major depressive disorder that is delivered via nasal spray. Spravato was developed by dividing the ketamine molecule and isolating one part of the molecule to turn it into a patented medication known as Spravato.
Spravato is administered in the clinic setting and requires monitoring for 2 hours after each treatment. Spravato requires that you also be currently taking an antidepressant medication in conjunction with Spravato treatments.
Because it is an FDA-approved treatment, insurance will cover this medication after certain requirements are met. Side effects, experiences during treatments, and exclusion criteria are similar to that of IV ketamine.
Psychedelics and Mental Health
Psychedelics: An emerging area in psychiatry gaining great interest is the use of psychedelic drugs like LSD, MDMA, psilocybin, and more to treat conditions like depression and severe trauma.
Treatment includes inducing a hallucinogenic and spiritual experience which may help people to find meaning and connectedness to others and the world around them.
There are currently studies underway evaluating the use of these substances for mental health conditions and it is believed that FDA approval is on the horizon for one or more of these drugs for use in psychiatry.
Get Evaluated for Innovative Treatments
Mental health conditions can be challenging to treat and it can take time to find an option that works for you. The good news is that groundbreaking developments continue to be made in psychiatry and if you struggle with treatment-resistant mental health conditions there is hope for you.
No matter where you are on your mental health journey we are happy to provide an evaluation of your mental health treatment history and make treatment recommendations appropriate to where you are in your journey, whether it be different medication options, therapy modality recommendations, or consideration for an interventional treatment like those discussed above, for which we can make a referral to local providers that offer these services.