Pharmacologically resistant (treatment-resistant) depression

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Treatment-resistant depression: when standard treatment doesn't work

Depression is one of the most common mental illnesses. It is usually treated with antidepressants, but unfortunately, these drugs do not help all patients.

📊 According to a study (Journal of Clinical Psychiatry, 2021) , almost a third of patients do not respond to first-line medication within 1–3 months of starting therapy. This condition is called treatment-resistant (TRD) or drug-resistant depression .

How is TRD diagnosed?

TRD is usually diagnosed in cases where:

The patient was taking at least two different antidepressants in adequate doses;
The duration of each course was at least six weeks ;
There was no noticeable improvement in the condition.

Such situations require a review of treatment: changing the drug, combining medications, or using alternative methods. However, even this does not always give the expected result.

Who is at risk?

🎯 Although it is difficult to predict TRD in advance, some groups are at higher risk:

Women;
Elderly people;
Individuals with severe or frequent depressive episodes;
Patients with comorbidities (physical or mental);
People with sleep disorders, eating disorders, and substance addiction.

Causes of treatment resistance

Among the main reasons:

Incorrectly selected therapy (dose, drug, duration);
Failure to comply with doctor's recommendations due to low motivation;
Psychological secondary benefit from a depressive state;
Side effects of antidepressants;
Strong external stressors (conflicts, financial problems);
Insufficient or inaccurate diagnosis;
Interaction with other drugs that reduce the effectiveness of treatment.

Modern methods of treating TRD

Common approaches include:

Combined drug therapy;
Intensive psychotherapy;
Electroconvulsive therapy;
Transcranial magnetic or electrical brain stimulation.

However, the use of ketamine is considered a particularly promising method.

Ketamine: a new approach in the treatment of resistant depression

Кетамін — єдиний психоделічний препарат, дозволений до медичного застосування. Його ефективність при ТРД і ПТСР підтверджена численними дослідженнями.

In particular, the article “The concept of reducing resistance in the treatment of depression: a focus on ketamine” (International Journal of Molecular Sciences, 2022) describes the potential of ketamine as a tool that restarts neuronal connections and alleviates symptoms.

Advantages:

Rapid onset of action - a noticeable effect is possible after the first infusion;
Impact on the deep neurobiological mechanisms of depression;
High tolerability and controlled side effects;
A real chance of recovery for patients who have not been helped by other methods.

Ketamine not only reduces symptoms, but also changes the approach to treatment, opening up new possibilities for millions of people.

Expio Center: the first in Ukraine

З 2018 року Центр Експіо — перший та єдиний медичний заклад в Україні, що легально застосовує кетамінову психотерапію.

We combine:

Ketamine infusions;
Psychotherapeutic support;
Transcranial electrical stimulation (TEC);
Rehabilitation neuroprograms;
Body-oriented techniques.

TRD is not a sentence. It is a challenge that can be overcome with a comprehensive, modern, and humane approach.

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