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Treatment options can include many different modalities. Usually the first level of alternative care is achieved by increasing the dose, changing or adding (augmentation) antidepressants or other non-antidepressant medications such as Lithium, several atypical antipsychotics, stimulants or thyroid hormone for example. Again, adequate doses and duration are required. Patients must first be able to tolerate the medications or combinations due to the potential side effects or adverse reactions that always pose a potential risk.
The risks and benefits for all medications recommended should be discussed with the patients before they are tried. The discussion should also include any alternative therapies, and/or the possible outcomes if a patient choses to forgo the recommended treatment. The patient must understand and then agree, or not, to the treatment plan being suggested before it is begun. This is the process of informed consent.
In addition to other modalities of treatment, Electroconvulsive Therapy (ECT) can be safely utilized for severe refractory depression or in patients with serious depression who cannot tolerate standard antidepressant medications.
Vagus Nerve Stimulation, Transcranial Magnetic Stimulation, and other newly emerging methods of direct and select brain stimulation have been shown to produce efficacious results as well. The arsenal of successful treatment also includes Ketamine IV infusion for resistant depression.
Psychotherapies of varying types have been assessed as effective and often necessary methods to assist with medication therapies in the fight against refractory depression; i.e. Cognitive Behavioral Therapy, Interactive-Interpersonal, Dialectical Behavioral and yes, even Analytical in some cases, have all been proven to be potentially effective. Treatment to remission, meaning no remaining symptoms, needs to be the goal or recurrence is likely.
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