Re: treatment resistand MDD, now what? » swim

I'm not sure whether or not any professional organizations here in the U.S. have put forth guidelines that recommend how to best treat cases of depressive illness that do not respond favorably to psychiatric medications. From my perspective, it makes sense that if there are any evidence-based treatment interventions other than medications that haven't been tried, such interventions ought to be looked at, especially if the risk of adverse effects from the treatments is low. With it being the case that major depressive disorder and other depressive illnesses are indeed health conditions, I'd recommend discussing any treatments options that you might be considering with a qualified professional before making use of them. Forums like this one are good for ideas, but I think that if a person does come across an idea on a forum like this that sounds promising, the person in question ought to discuss the idea with a qualified professional before deciding to use a treatment for a condition like major depressive disorder that the person might have come across on the Internet.

Having said what I've said, I'm going to mention a few treatment interventions other than medications that are used for major depressive illness and other depressive illnesses. My understanding of the treatment interventions that I'm about to mention is that these treatments tend to have more evidence to support their use than some treatment interventions that I'm not going to mention, but it isn't my intention to put together a complete list of all treatments for depressive illness that have a large body of evidence to support their use. Rather, it's my intention to touch on a few treatment interventions for depressive illness that might be worth considering.

To start with, talk therapies, most notably cognitive-behavioral therapy and interpersonal therapy, have been shown to be effective in the treatment of depressive illness, and there's also some evidence that utilizing talk therapy along with taking medications tends to lead to better results than utilizing either form of treatment alone. Exercise is another intervention for the management of depressive illness that some studies have found to be beneficial, and even though I'm not sure if exercising along with utilizing talk therapies and/or medications has been demonstrated to lead to benefits that are more pronounced than using a single treatment modality, it makes sense that using more (rather than fewer) treatment interventions that have a reasonable chance of being beneficial would only increase your chances of having a favorable outcome. Two other treatments that mainstream psychiatrists are known to use for depressive illness are electroconvulsive therapy and repetitive transcranial magnetic stimulation. The latter treatment, rTMS, has received approval from the U.S. Food and Drug Administration specifically in the treatment of those with depressive illness whose symptoms have not responded to other treatments. ECT is also used for treatment-resistant depression, and it's considered to be one of the more effective treatments for cases of depressive illness that are severe and life threatening, but ECT also has a more extensive side-effect profile than most (if not all) treatments used in psychiatry and thus tends to only be used in certain situations.

Other than talk therapies, exercise, rTMS, and ECT, some alternative treatments for depressive illness also have some evidence to support their use (even though the strength of the evidence varies depending on the treatment). Complementary health practices that have been suggested to be beneficial for those with depressive illnesses include acupuncture and meditation, and several dietary supplements have also been shown to improve mood. Among the supplements that I'd consider to have the most potential for those with depressive illnesses are St. John's Wort, SAM-e, vitamin D3, omega-3 fatty acids, Rhodiola rosea, curcumin, and 5-HTP. Rhodiola rosea and curcumin might be of particular interest to you because there's some evidence that, like Nardil, they inhibit the monoamine oxidase enzymes.

With respect to vitamin D, scientific reviews have actually stated that low levels of the vitamin (or hormone, to be even more accurate) have been found to be correlated with major depressive disorder. My understanding is that it hasn't been established whether low vitamin D levels might cause depressive illness, or whether the relationship between low vitamin D levels and depressive illness might be explained in other ways. Almeida and colleagues (2015) have suggested that low vitamin D levels are more likely to be a consequence of depressive illness than a cause of the illness, based on findings that low vitamin D levels have been found to be associated with current depression, but not past or future depression. However, the authors also stated that more large randomized placebo-controlled trials designed to evaluate the efficacy of vitamin D3 in patients with depressive illness who have low levels of the vitamin/hormone are needed before conclusions can be made about how low vitamin D levels and depressive illness might be causally related. I have some reason to believe based on all of the information that I've come across on vitamin D that the benefits of vitamin D3 supplementation might take longer to become apparent (perhaps several months or longer) than the benefits of most potential treatments for depressive illnesses, but this might not be true in all cases. At any rate, increasing your vitamin D level -- whether it's by getting more sunlight, by eating more vitamin D-rich foods, or by taking vitamin D3 supplements -- might conceivably help to relieve your depression if your level of the vitamin/hormone is low, and so, I think that getting your vitamin D level checked might be worth looking into, if there's any way that you can do that.

Well, I know that I've just put a lot of ideas out there regarding treatment interventions that you might want to consider. Considering that you've described your depression as treatment resistant, it wouldn't surprise me if you've already tried some of the ideas that I've suggested, but it's my hope that there's at least an idea or two out of all of the ideas that I put forth that you haven't tried and might find to be at least somewhat promising. As I said, I do recommend that you consult with a qualified professional before utilizing any treatment ideas that I've put forth or that anybody else here might forth, but at the same time, I hope that you'll end up getting at least an idea or two from the members who post here that you'll ultimately find to be beneficial.

Almeida, O.P., Hankey, G.J., Yeap, B.B., Golledge, J., & Flicker, L. (2015). Vitamin D concentration and its association with past, current and future depression in older men: The Health in Men Study. Maturitas, 81, 36-41. Abstract: http://www.maturitas.org/article/S0378-5122%2815%2900033-X/abstract

"Maybe someday
We'll figure all this out
We'll put an end to all our doubt
Try to find a way to just feel better now"

- Rob Thomas

Re: treatment resistand MDD, now what? » swim

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