Three tools to tackle treatment-resistant depression, from an Inova psychiatrist

Eric C. Alcera, MD, MBA, DFAPA, DAACAP, is the President of the Behavioral Health Service Line at Inova. He is double board certified in child and adolescent psychiatry and adult psychiatry and has more than 20 years of experience in behavioral health. His particular specialties include pediatric psychopharmacology and the treatment of depression, anxiety and trauma.

Depression is more than sadness. It’s a serious condition that affects both body and mind. And it’s very common: In Fairfax County, VA, for example, about 160,000 adults are diagnosed with depression. Depression can cause suffering in almost every area of life, and it’s important to have access to effective treatments.

The most common symptoms of depression include a low, sad or empty mood that is long lasting or intense, leading people to lose interest in things they once loved, feel irritable or restless, struggle with fatigue or low energy, have trouble making decisions, or feel hopeless. It can also cause physical symptoms from headaches and gastrointestinal issues to problems with sleep or appetite.

Depression can often be effectively treated with medication – but unfortunately, medication doesn’t work for everyone. In fact, one-third of patients who are diagnosed with depression will ultimately fall into treatment-resistant depression. That’s defined as depression symptoms that have not gotten better after trying two or more medications. In Fairfax County, that translates to about 50,000 adults.

Neuromodulation offers options – and hope

Treatment-resistant depression is challenging, but there is good news. There are effective treatments that have been approved by the U.S. Food and Drug Administration (FDA), three of which are available at Inova. The name for this category of treatments is “neuromodulation” – and it works differently than the widely used class of antidepressants used to treat major depressive disorder.

Each neuromodulation intervention has a unique way of working, but in general, it’s helpful to think about it like resetting a computer. Whether it uses electricity, magnetic stimulation or a drug, neuromodulation impacts the pathways within the brain to enable the brain to respond better to new or continuing medication management.

Electroconvulsive therapy (ECT)

Probably the most studied neuromodulation treatment in psychiatry, about 73% of patients respond to ECT. It uses carefully targeted pulses of electricity to “reboot” the part of the brain responsible for depression symptoms. In addition to treatment-resistant depression, ECT treats schizophrenia, bipolar disorder, OCD, catatonia and even some neurological disorders. Inova offers ECT at Inova Fairfax and Inova Mount Vernon hospitals, with plans to expand it to Inova Loudoun Hospital as well.

Transmagnetic stimulation (TMS)

TMS is a strong option for those who can’t tolerate anesthesia or don’t want to be admitted to the hospital. It works in a similar way to ECT, but it uses magnets instead of electricity to achieve symptom improvement. And unlike ECT, which is done in the hospital, TMS is typically done in an office setting. It shows robust results when compared to ECT, the gold standard in treatment-resistant depression therapies. Inova offers TMS at our Fairfax and Alexandria outpatient behavioral health offices.

Esketamine

Esketamine is an FDA-approved drug for treatment-resistant depression. It is given as a nasal spray in an outpatient office setting. The therapeutic results are similar to those of ketamine, and it offers fast-acting results. Inova is bringing eskatamine to outpatient behavioral health offices.

Lifesaving interventions for treatment-resistant depression

All three of these interventions are FDA approved, and insurances typically cover them. They are not just elective therapies – they are life-saving procedures, given that suicidal thoughts or actions are common symptoms of treatment-resistant depression.

Neuromodulation can fit into patients’ treatment plans in several ways. For example, patients can get ECT on a regular maintenance schedule, coming in every few months as symptoms begin to creep back in. Another option is to get a course of neuromodulation treatment and then go back to a regular antidepressant medication regimen under a psychiatrist or primary care provider’s supervision. Patients may also benefit from neuromodulation before they switch to a new depression medication, to “reset” the brain.

Neuromodulation can help people get the relief they need from these life-impacting disorders. Instead of going through the same symptom cycle again and again, these treatments increase the possibility that patients will have a positive response the next time they’re treated, rather than going back to the treatment that wasn’t controlling symptoms very well.

If you’ve been diagnosed with depression but are not finding relief from your symptoms, talk with your healthcare provider. There is a wide variety of treatment options – including neuromodulation – that can make all the difference in your quality of life.

Learn more about Inova Behavioral Health Services.