Some mental health conditions prove more challenging to manage than others. Treatment-resistant depression is a particularly stubborn condition, often requiring unique therapeutic strategies to manage. Dr. Lou Ann Eads is the program director of geriatric psychiatry residency and the program director for interventional psychiatry at the University of Arkansas for Medical Sciences (UAMS). Dr. Eads is an expert in treating anxiety disorders, depression, Alzheimer’s, and dementia, and what she calls treatment-resistant depression. She recently went on AFMC TV to help shed some light on this complex issue.
Understanding Treatment-Resistant Depression
Treatment-resistant depression, as Dr. Eads explains, is usually defined as a failure to respond to two or more antidepressants taken at the maximum possible dose for an adequate duration without experiencing adverse side effects. “We encounter this form of depression in around 10% of the population,” Dr. Eads notes, highlighting the significant challenge it poses for patients and providers.
Innovative Approaches to Treatment
Dr. Eads and her team at UAMS have explored a variety of innovative treatments beyond conventional therapy and medication management. “We’ve started looking at various inhibitions and ways to manage this type of depression, including electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and ketamine therapy,” she says.
Notably, ketamine therapy has emerged as the most promising option, particularly for more severe cases. Initially recognized in the mid-90s for its potential psychiatric benefits, ketamine's role in treating depression has evolved significantly. “The development of a nasal spray, called S ketamine, marked a significant advancement. It was released with FDA approval under what’s called a Risk Evaluation and Mitigation Strategy or (REMS) program,” Dr. Eads explains.
According to the Centers for Disease Control and Prevention, a REMS program is designed to reinforce medication behaviors and actions that support the safe use of that medication. They focus on preventing, monitoring, and managing risk by informing and reinforcing patient actions to reduce the frequency or severity of an event.
“S-ketamine offers hope for those with severe depression without the side effects you might see with other treatments, such as ECT,” Dr. Eads says.
The Benefits of Ketamine Therapy
Dr. Eads is quick to point out the individual-dependent nature of ketamine therapy’s success. “About a third of our patients experience substantial benefits, achieving near remission of their depression symptoms as long as they keep progressing in their maintenance program. Another third show some improvements with S-ketamine, and the last third of our patients don’t show much improvement with the nasal spray.” However, this 33% success rate is notable, especially considering the complexity of the condition for which the therapy is used.
Collaborative Care: The Role of Primary Care Providers
Collaboration between primary care providers (PCPs) and psychiatrists is key in managing treatment-resistant depression. “We feel that patients with treatment-resistant depression should have already visited with a psychiatrist or psychiatric provider before coming to us,” Dr. Eads says.
A referral from a PCP to a specialist like a psychiatrist can be helpful for patients struggling to find effective treatment options. The psychiatrist can then work with the patient to identify other medications and treatment options the PCP may not have tried with the patient. This collaborative approach ensures all possible avenues are explored before moving on to more advanced interventional techniques.
Clearing Up Misconceptions
Despite their promising results, advanced treatments like ketamine therapy are often full of misconceptions. Dr. Eads helps clarify these points:
- ECT remains a highly effective treatment, but it carries risks, the most concerning being the potential risk for possible memory issues.
- TMS is also a viable option for milder forms of treatment-resistant depression
- S Ketamine provides a valuable strategy for severe cases, enhancing the effectiveness of other antidepressants while minimizing the need for medication changes.
Final Thoughts
Dr. Lou Ann Eads and her team at UAMS have promoted innovative treatments and collaborative approaches to battling treatment-resistant depression. By demystifying the options available and emphasizing the importance of personalized care, they offer hope to those whose traditional treatment methods have fallen short.
Dr. Eads’s insights provide a valuable resource for healthcare providers looking to deepen their understanding of these advanced treatments. In the ever-evolving field of psychiatry, staying informed on the latest treatments is crucial for offering the best care to patients struggling with treatment-resistant depression.
Learn more about the UAMS Psychiatric Research Institute and the Walker Family Clinic.
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