Naomi Judd’s death sheds light on treatment-resistant depression. Here’s what can help.

For a decade as a young adult, Hannah Wyatt Sultan struggled with depression that weakened her daily life.

After many rounds of different antidepressants and therapies, Sultan was still not experiencing remission from the disease – and she was getting frustrated.

“You lose confidence in yourself and your own abilities,” Sultan said.

Sultan, as she later learned, suffered from what is called treatment-resistant depression, which was not alleviated by antidepressants or psychotherapy. It wasn’t until 2020 that the now 28-year-old Denver resident was able to land on a treatment — electroconvulsive therapy — that worked for her.

But Sultan isn’t the only one battling treatment-resistant depression – a condition highlighted by the death last month of country music star Naomi Judd, who admitted she was suffering from depression. severe form of the disease and was a strong advocate who tried to shine a light. on treatment-resistant mental illnesses.

People are considered to have treatment-resistant depression after they have tried to treat their depression with at least two or three different antidepressant treatments in sufficient doses over a period of time without success.

Denver-area experts say there are, in fact, several ways to successfully treat treatment-resistant depression, including through electroconvulsive therapy, which worked for Sultan.

Dr. Christopher Schneck, medical director of the Helen and Arthur E. Johnson Depression Center at the University of Colorado’s Anschutz Medical Campus, estimates that 15 to 30 percent of people with depression encounter treatment resistance. At the same time, 17% of the American population suffers from depression during their lifetime, he said.

“We have no way of really knowing which drug is going to work for which person, other than trying drugs,” Schneck said.

Sultan continued to seek help and try different avenues of treatment before being told of the treatment-resistant depression. When a friend in nursing school approached her about trying electroconvulsive therapy, she thought about it for a few weeks before meeting Dr. Konoy Mandal at UCHealth.

ECT treatment is intense, with patients having to undergo general anesthesia as the electrical currents target specific parts of the brain. Sultan barely remembers his life during the acute period of treatment for the first few weeks.

She was terrified before the first treatment and remained nervous before the next ones, then got excited when she saw the results a few days later.

“I woke up and was like, ‘Oh my God, I’m actually wide awake and happy right now! ‘” Sultan said. “I was a little impressed.”

ECT brought a much-needed change to Sultan’s life that removed the obstacles created by his years-long depression.

Mandal and Schneck said ECT has a 70% to 80% success rate, but other options are available for those with treatment-resistant depression.

Dr. Eve Langston, an anesthetist who started Vitalitas Denver Ketamine Clinic, said about 70 percent of people with treatment-resistant depression will experience success with ketamine infusion. The anesthetic is infused intravenously and if patients respond successfully, treatments continue every three to six weeks, as appropriate.

Although ketamine is not approved by the Food and Drug Administration, esketamine, a variant of the drug delivered by nasal spray, is approved by the FDA.

Schneck said this distinction is most important when it comes to insurance coverage, since insurance companies generally won’t pay for treatment that isn’t FDA-approved.

Seeking help for treatment-resistant depression can force patients to rule out more expensive options, Schneck said, even though they might otherwise be helpful.

Schneck said a third approach to relieving treatment-resistant depression beyond ECT and ketamine is transcranial magnetic stimulation, which uses magnetic fields to stimulate particular parts of the brain to treat depression. depression and other illnesses.

The FDA has approved the machine for use in major depression, anxiety depression, obsessive-compulsive disorder, and smoking cessation. Schneck said some insurance companies will cover TMS treatments for these conditions, but not others, which means the treatment would instead have to be paid out of pocket for typically close to $1,000 for the 4 to 6 process. weeks. .

Schneck’s concerns about expensive mental health care extend statewide, as 20% of Colorado residents struggle with mental illness, according to the Colorado Behavioral Health Task Force. In addition, nearly 361,000 residents are uninsured.

Despite the difficulty of access and money, Schneck, Mandal and Sultan said they hope patients will continue to seek treatment until they reach remission, defending themselves as they would if they had another illness.

“It’s really about, in the middle of the frustration of having depression, not being frustrated that the things you’re trying aren’t working and not blaming yourself and realizing it’s not your fault. “Sultan said. “You have to go on, though.”

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