Treatment Resistant Depression: Here's Multiple New Options

If meds don't work for you, explore these promising new theories and techniques.

Posted Jul 23, 2018

(c) Fotosmurf/fotosearch
Source: (c) Fotosmurf/fotosearch

If you have been feeling seriously depressed and yet no antidepressant medications seem to help, a report this past week in the July 15 issue of Neuroscience may offer a new explanation for why. This breakthrough idea will hopefully lead to new treatment options, as our current antidepressants offer relief for only approximately 60 percent of those who try them, with little, no, or negative impact on 30-40 percent of depressed individuals. 

Depression triggers feelings of hopelessness and helplessness. It fills your thoughts with self-criticism, and with negative thoughts about your future and other people. Depression lowers your energy level and invites disinterest in doing any of the activities that you would normally find appealing. Depression saps the fun out of life. So if you feel depressed, you no doubt will want to find a way to get back to feelings of well-being as quickly as possible.

What neurobiological changes are presumed to occur with depression?

Japanese neuroscientists Yumiko Saito, Yuki Kobayashi and their colleagues from Hiroshima University in Japan, reporting in the journal Neuroscience, have discovered a new hypothesis.  Maybe, these scientists are saying, some folks’ depressive reactions are not due to the usual suspect, which is low levels of the chemical called serotonin. Most antidepressants aim to help by raising serotonin levels. When serotonin depletion is not the problem, this treatment strategy understandably fails. 

The Japanese hypothesis on what causes some types of depression focuses on a different component of brain functioning. The Neuroscience article reporting on this finding states, "Depression-like behavior in RGS8tg might result through RGS8-ciliary MCHR1 interaction in the CA1 region."

Find that explanation a bit opaque?

Enter science writer Peter Dockrill. Writing in a recent issue of Science Alert, Dockrill translates the Japanese neuroscientsts’ technical sentence as follows: “When the researchers examined euthanised animals' brains under a microscope, they found that RGS8-boosted mice demonstrated longer neuronal cilia (in which MCHR1 is localised) than regular mice did, in a region of the hippocampus called CA1.”

The meaning of this sentence?

There may be a phenomenon having to do with the length of cilia (tiny hair-like structures) in neurons in the hippocampus that is associated with depressed emotional states.

We’re closing in on it, but we’re not there yet.

What especially interested me in Peter Dockrill’s article was his explanation of how the Japanese scientists had tested their hypothesis. They took mice to a swimming pool—that is, to a closed tank of warm water—to see which mice would keep swimming and which were more prone to give up. 

Dockrill’s explanation of what happened to the swimming mice hones in on the essence of depression: Mice with normal cilia swam longer than those with the abnormal-length cilia. “Constantly monitored as they swim around for a while,” the normal mice swam longer “before going immobile or ‘giving up’, which is considered a characteristic similar to depression.”

Yet another new theory of the cause of treatment-resistant depression.

Another new theory, reported recently in Proceedings of the National academy of Science, links depression with the acetyl-L-carnitine molecule.  Low levels of this chemical consistently correlate with depression that current drugs do not seem to be able to relieve.  The other especially convincing part of this research is that the lower the levels of acetyl-L-carnitine, the worse the depression.  This chemical therefore sounds particularly promising as a theoretical and treatment breakthrough.

Scientists are developing a blood test that will be able to determine if a depressed person has low levels of this molecule. 

Even now, however, supplements are available that augment the levels of this molecule.  These supplements are used already in treatment of other disorders, specifically for memory loss and brain deterioration.  You can find these in any vitamin store, and even on Amazon.  Maybe they are worth a try.

A third treatment option if you have been feeling depressed

Dockrill wrote about the mice that, if they were depressed, they gave up on swimming toward their goal sooner than non-depressed mice. That is, one hallmark of depression is giving up on getting something that you desire. Probably, giving up is both a cause and an effect of depressed emotional states. 

(c) susanheitler
Taking the Fold Road in response to getting something you want fosters depression.
Source: (c) susanheitler

This view accords totally with the model of what causes depression that I present in my book Prescriptions Without Pills. I write there that depression results when someone who has hit a life bump (a dilemma, a problem, an unpleasant situation, a disagreement or conflict, etc.) folds—that is, gives up, with regard to getting what s/he wants.

Folding leads to depression. Fight Road breeds anger. Freeze (no longer trying to solve the problem but still aware of it) sustains anxiety. Flee leads to addictive and compulsive outcomes.  Only the Find Solutions Road leads to a return of well-being.

Psychotherapy options for treatment resistant depression

Research studies often conclude that, particularly if your depression has been triggered by an event or troubling situation in your life, psychotherapy is likely to be as or more helpful, and with longer-lasting results, than medications. 

Many therapists and much research focus on CBT (cognitive-behavioral therapy) treatment techniques.  Research again and again shows its efficacy. 

At the same time, another anti-depression therapy method I find to be particularly effective with my depressed clients is based on a visualization technique.  Closing eyes and doing this visualization exercise enables people to identify and find new solutions for the bump that triggered the giving-up reaction. The visualization re-empowers you so you have the strength and determination to ‘keep swimming.’  Feeling more empowered enhances your ability to see new solution options. 

The following video explains the three steps of this visualization technique.

My book Prescriptions Without Pills offers further details on how to do the above visualization.  You can try it on your own, ask a friend or relative to do the visualization with you, or do it with the. help of a therapist.  There's also another example illustrating the technique on the website that goes with the book.  This therapy technique has an added advantage: you can quite possibly do it without a therapist, either as self-help or with the help of a friend or family member.

Power Poses to combat treatment resistant depression's sense of insufficient power

Interestingly, a study from Harvard confirms the importance of reempowerment in over-coming depression and low self-confidenceThis study found that simply striking a Superman (or Wonder Woman) pose and holding this very upright and chest-out pose for two minutes creates remarkably energizing physiological changes. See here for more on this technique, including a rebuttal to its detractors.  Because this technique is free, takes just two minutes, can be done multiple times a day, and has no downsides, it certainly can be worth a try.

Couples therapy

Depression can be triggered by, or can inadvertently be sustained by, interactions between the depressed person and loved ones or people at work.  For more on how to prevent your marriage or workplace from making you depressed, see here.  For self-help remedies, see here.

Alternative treatment modalities for treatment resistant depression

In addition to medication and psychotherapy, increasing numbers of alternative medicine options offer hope. Do look into acupuncture, acupoint tapping, Emotion Code, Body Code, Heartmath, ketamine, canabinoids which are marijuana without the ingredients that create a high (see this article for a review of research), medically-supervised psychedelics and and many more. 

Many of these alternative techniques are frowned upon by psychiatrists and psychologists who prefer the more conventional "science-based" treatment methods.  At the same time, in clinical work where I have partnered with alternative therapist practitioners, I have seen some of these techniques produce remarkably positive results. 

The bottom line on depression treatment:

Thanks to the Japanese neuroscientists' work related above, if you do choose medication and the meds do not work, you can remind yourself that today’s antidepressants aim to relieve low serotonin levels, whereas your depression may be of the neuronal cilia abnormality type, of the low acetyl-L-carnitine, from having given up on getting something of import to you, or from yet another unknown-as-yet cause.

Do reassure yourself therefore that evermore treatment paths are emerging to alleviate the hopelessness, low energy and negativity of treatment resistant depression.  So if the first, second or even the third option that you try does not seem to help, for sure do keep swimming until you find the ones that do.