We’ve grown slightly more comfortable in regard to discussing certain matters of pain and discomfort with those around us. When we’re sick, we let others know. When we’re hurt, we explain how it happened. Admitting something is wrong isn’t a sign of weakness anymore – at least, in some cases. But when the pain isn’t quite so obvious, we still do our best to hide it – and too many of us still believe that mental pain is nothing more than personal weakness.
In fact, some people believe that mental health issues – conditions like depression and anxiety – aren’t a medical problem. Some think these conditions are blown out of proportion, despite the fact that millions of Americans struggle with mental health issues like depression, causing a massive loss of productivity, and in the worst cases, loss of life.
The facts are that depression is not a normal state of being. And it is, in fact, a traceable problem in certain people’s neurobiology. You can’t simply pray or think your way out of a depression. Family support, community support, therapy and, yes, prayer, can help individuals overcome their depression. But you also need treatment.
Most Americans who struggle with a diagnosable depressive disorder do not seek treatment. Most go on to live their lives without getting the help they need or start seeking help and stop before treatment has a chance to work. Many end up taking their life or go through decades of guilt and grief over their own perceived weakness.
However, many do get the help they need – through the help of a medical professional, they receive medication and therapy. But what happens when the medication doesn’t work? Antidepressants can be very effective in the treatment of depression, but they’re still largely misunderstood. Some believe they can make any case of depression go away, while others believe they’re more poison than cure.
How Antidepressants Work
Antidepressants are a class of medicine that affect the brain by blocking the reuptake of a chemical called serotonin. This is a chemical the brain produces naturally, and it’s released more vicariously during certain activities. Serotonin is, in some interpretations, a chemical responsible for happiness. More accurately, serotonin plays a role in mood regulation, hormone regulation, appetite, the immune system, and other functions. SSRIs, or selective serotonin reuptake inhibitors, help people with depression by increasing the amount of serotonin available in their brain. This can have a tremendous effect on people with depression, who may be struggling with their thoughts specifically because their brain fails to properly manage serotonin levels.
This isn’t always the case with depression, which is why doctors and psychiatrists work with patients and give them tests to get a better understanding of their condition and possible treatment options. For example, some people experience symptoms of depression due to an endocrine disorder and do better on medication to help regulate their thyroid than antidepressants.
The exact formulation for each kind of SSRI differs from brand to brand, and for good reason. Not everyone responds the same way to a given SSRI. Zoloft, Prozac, Celexa and Lexapro all work in different ways for different individuals. One drug might be effective, one might not be, and two of them might cause side effects for you. Some of these include temporary weight gain, or more permanent symptoms, like sexual dysfunction while taking the drug.
These side effects can make certain types of SSRIs not viable as medication for some people. This means their doctor has to prescribe something else. For most people, it takes one or two test runs before they find a drug that works for them. Others, however, don’t respond well to any SSRIs. Some get the side effects without feeling better at all. That’s when doctors start recommending other types of antidepressants, including SSNRIs, TCAs, as well as less common antidepressants such as MAOIs. Depending on a doctor’s recommendation, however, some patients eventually reach the point where no medication seems to be having a positive effect on their depression, or at least not without serious side effects.
When Antidepressants Fail
When a patient doesn’t respond to antidepressants and isn’t getting better solely with therapy, alternative options spring to mind. Some of these are invasive, including vagus nerve stimulation, neuromodulation, and, in the most extreme of cases, very minor brain surgery.
But on the side of non-invasive treatments, one stands out above others: transcranial magnetic stimulation (TMS) therapy. Unlike many other non-pharmacological depression treatments, TMS doesn’t require extensive prep or anesthesia, and it also comes with the added benefit of having no lasting side effects. This means anyone can try TMS therapy, and they will have nothing to lose, with no risks involved.
In theory, TMS is quite simple – yet its efficacy is undeniable. It’s highly effective specifically for treatment-resistant depression, especially when coupled with cognitive-behavioral therapy, which is a type of talk therapy many therapists utilize when treating patients with depression and depressive disorders.
dTMS for Depression
TMS therapy, or dTMS therapy (deep transcranial magnetic stimulation) effectively treats depression by sending magnetic waves in pulses to a portion of the brain responsible for the management of a person’s mood. This seems to relieve symptoms of depression over several different sessions. Patients are usually instructed to complete a full program by attending several sessions per week, for about a month.
Each session lasts less than 30 minutes, and largely involves sitting in a comfortable reclining chair while a professional administers the treatment through a machine. The magnetic waves are sent into the brain through an H-coil within specially-designed headgear, which a patient wears throughout the session. The magnetic waves have been described to feel like a slight tapping sensation and are not painful at all.
There Is No Best Answer
Transcranial magnetic stimulation is highly effective for many people who struggle with treatment-resistant depression. But it isn’t a guaranteed success. The same goes for antidepressant medication, which can be very effective, but isn’t guaranteed to be.
Depression treatment depends entirely on an individual, and how their brain responds to different modes of treatment. That’s why it’s important to try everything, until something works. Don’t give up hope.