It’s important for anyone struggling with their mental health to understand that when a person struggles with mental illness, their brain chemistry changes. We often think of anxiety, depression, and other mental health conditions as though they are limited to thoughts and feelings – something that can be controlled with talk therapy alone.
Sometimes, that’s true. Therapy can be an amazing tool for overcoming mental health challenges. But it’s still important to remember that, again, we experience *brain chemistry changes* when we have a mental illness.
As a result, sometimes we need more than just therapy. Sometimes we need treatments that can help alter or address these brain chemistry changes.
And sometimes, even those may not work right away.
Introduction to Treatment Resistant Depression
It’s important to understand that depression is treatable. Most, if not all depression, can be treated with the right combination of therapy, medication, or other approaches – like TMS.
Still, the key words there are “right combination.” There is no one size fits all approach to treating depression. Some people are able to treat it with talk therapy alone. Others use medications. Still others require alternative treatments, like transcranial magnetic stimulation.
In all of these cases, a treatment is often available. We just have to find it together.
Sometimes, what happens to patients is that the first treatments they try are not the right ones or not as effective as they could be. When a patient has tried many different treatments and still feels depressed, we may refer to this as “treatment resistant depression,” indicating that the initial treatments we tried did not work.
Note: “Resistant” doesn’t mean untreatable. It just means that the solution may not have been one of the first ones that we tried. Thanks to treatments like TMS therapy, there are always more options available.
Why Would Depression Be Treatment Resistant?
Depression is one of the most common mental health challenges in the world. It is also one that can have a dramatic affect on your brain and your brain chemistry. Depression causes – and can be caused by – real, measurable changes to your brain chemicals and structure.
Neurotransmitters are chemical messengers that transmit signals between nerve cells (neurons) in the brain. Several key neurotransmitters are implicated in depression:
- Serotonin – Often referred to as the “feel-good” neurotransmitter, serotonin plays a crucial role in regulating mood, anxiety, and sleep. In depression, serotonin levels are often reduced, leading to symptoms such as sadness, irritability, and sleep disturbances.
- Dopamine – Dopamine is involved in motivation, pleasure, and reward. In depressed individuals, dopamine activity is typically diminished, which can result in anhedonia, or the inability to feel pleasure, and a lack of motivation.
- Norepinephrine – This neurotransmitter is associated with alertness, energy, and the body’s stress response. Low levels of norepinephrine in the brain can contribute to the fatigue, lack of energy, and decreased concentration commonly seen in depression.
It’s important to understand that stress and the issues that lead to depression can cause these imbalances. Our experiences and thoughts can cause neurotransmitter imbalances and vice versa.
In addition to these imbalances, depression can cause changes in brain structure and function. The hippocampus, which is involved in memory formation and emotional regulation, tends to be smaller in people with depression. This shrinkage is thought to result from prolonged exposure to stress hormones like cortisol, which can damage neurons in the hippocampus. This can lead to memory problems and an increased risk of developing persistent depression.
The amygdala is the brain’s emotional center, responsible for processing emotions such as fear and pleasure. In depression, the amygdala may become overactive, leading to heightened emotional responses, such as excessive feelings of guilt, sadness, or anxiety.
The prefrontal cortex is involved in decision-making, problem-solving, and regulating emotions. Depression is often associated with reduced activity and volume in the prefrontal cortex, which can contribute to difficulties in concentration, decision-making, and controlling negative thoughts.
Why Does This Matter?
Once you understand that depression can, quite literally, change how our brains function, it becomes easier to understand why treating depression is not always straight forward. Even though it is a mental health condition that can, in many cases, be treated with therapy or medication alone, there are many other situations where a person has undergone many treatments that have not been successful.
When we understand that depression can alter brain chemistry, we can then understand why it may be harder to treat in some situations.
Depression Remains Treatable
Despite the existence of treatment resistant depression, it is so important for anyone that is experiencing symptoms to understand that depression is treatable. Hopelessness is a symptom of depression. There are options available, and more are being created every day.
If you feel like you have treatment resistant depression in the Dallas area, you may want to consider TMS therapy. Aware Behavioral Health uses TMS on patients that have tried other types of depression treatments and found them to be unsuccessful. It is one of the many options we have available at our office. Learn more by contacting Aware Behavioral Health, today.
