For millions, the standard approach to depression starting a selective serotonin reuptake inhibitor (SSRI) or a similar medication leads to significant improvement. However, when a patient has tried two or more different antidepressant treatments (administered at an adequate dose and duration) without a satisfactory response, they are often diagnosed with Treatment-Resistant Depression, or TRD.
TRD is not a distinct illness; rather, it represents a classification of major depressive disorder that has proven difficult to manage with conventional approaches. This can lead to profound disability, increased risk of hospitalization, and significant patient distress, as individuals cycle through various combinations of medications, doses, and therapies searching for relief.
Why Traditional Treatments Fail
Traditional antidepressants primarily target the monoamine neurotransmitters (serotonin, norepinephrine, and dopamine). For many years, the standard treatment escalation involved switching between classes of these monoamine-based drugs or adding a second medication (augmentation) like lithium or an atypical antipsychotic.
However, researchers now understand that TRD may involve neurobiological pathways beyond monoamines, particularly those related to glutamate, the brain’s primary excitatory neurotransmitter, and structural changes in key brain areas responsible for mood and cognition. When the monoamine-based drugs fail, it signals a need to step outside the conventional pharmacologic box and explore treatments that can rapidly influence neuroplasticity, which is precisely where compounds like esketamine enter the picture. TRD underscores the necessity for new, faster-acting treatment modalities that can rebuild and reconnect damaged neural circuits.
At Light-tunnel Behavioral Health Services in New Haven county, providers are able to properly diagnose and treat TRD. Inquire within.