How Do You Know if Your Depression Is Treatment-Resistant?
The renowned Buddhist monk Thich Nhat Hanh famously said, “Fear keeps us focused on the past or worried about the future. If we can acknowledge our fear, we can realize that right now we are okay. Right now, today, we are still alive, and our bodies are working marvelously – Our eyes can still see the beautiful sky – Our ears can still hear the voices of our loved ones.” Many people are fearful when they discover that their depression is treatment-resistant. However, there are many modalities that, when combined, can help to break that resistance down.
The Prevalence of Mental Illness in the U.S.
Mental illness remains highly prevalent in the U.S. (and around the world). Millions of people struggle with mental illness every day. Unfortunately, many people do not get the help that they need. This is for many reasons.
One, people don’t realize that they are struggling with mental illness. Two, they are unsure how to get the help they need. Three, they are unsure how they are going to pay for the help they need. Four, they don’t feel that mental illness is a problem that needs to be addressed professionally. This last one can be especially true with depression.
Better Understanding Depression
According to the National Institute of Mental Health (NIMH), major depression is one of the most common mental disorders in the U.S. For some individuals, major depression can result in severe impairments that interfere with or limit one’s ability to carry out major life activities.” Also, “An estimated 21.0 million adults in the United States had at least one major depressive episode. This number represented 8.3% of all U.S. adults.” Certainly, these are not insignificant statistics.
However, the key is to not get frustrated with these statistics, but rather to get motivated. This is what we believe here at Exclusive Hawaii Rehab. We feel that it is our primary purpose to help individuals recover from their issues of depression, other mental illnesses, and addiction.
What Causes Depression?
There are many causes of depression. A study in the peer-reviewed journal Brain Sciences, titled “Biological, Psychological, and Social Determinants of Depression: A Review of Recent Literature,” showed that “there are a plethora of risk and protective factors (relating to biological, psychological, and social determinants) that are related to depression; these determinants are interlinked and influence depression outcomes through a web of causation.”
There are also many other causes of depression. One major cause of depression is addiction. However, this can be difficult to gauge because the question is often posed, “What came first, the addiction or the depression?” This is interesting because alcohol is a depressant so it certainly can lead to depression. Yet, many people self-medicate with alcohol and substances for their depression. Ultimately, when combined addiction and depression are very dangerous.
What Are the Types of Depression?
There are many different types of depression. The two most common types of depression are major depression and persistent depressive disorder. According to NIMH, “There are different types of depression, some of which develop due to specific circumstances. Major depression includes symptoms of depressed mood or loss of interest, most of the time for at least 2 weeks, that interfere with daily activities,” and “persistent depressive disorder (also called dysthymia or dysthymic disorder) consists of less severe symptoms of depression that last much longer, usually for at least 2 years.”
Other types of depression include perinatal depression, seasonal affective disorder, and depression with symptoms of psychosis. Also, as will be discussed in length, there is depression that is treatment-resistant.
The Signs and Symptoms of Depression
Now, of course, depression exists on a large spectrum which makes it rather hard to make a complete list of its signs and symptoms. However, there are some more universal signs and symptoms of depression that one can look out for. The following are just a few of those signs and symptoms:
- Isolating away from family and close friends
- Losing interest in activities once enjoyed
- Struggling to get out of bed and excessive sleeping
- Not getting enough sleep (insomnia)
- Feeling anxious, nervous, or overly “stressed out”
- Loss of appetite
- Trying to self-medicate with alcohol and/or substances
- Feeling like there is no purpose to life
- Having thoughts of worthlessness, hopelessness, and uselessness
- Expressing feelings like one wants to hurt oneself or others
- Committing self-harm
- Having suicidal ideations
- Attempting suicide
As one can see, these are scary and significant signs and symptoms. This is why if any, many, or all of these symptoms are present, it is important to seek professional help as soon as possible. Doing so could mean the difference between life and death – between short-term side effects and long-term consequences. Now, this help becomes more complicated when the depression is treatment-resistant.
What Makes Depression Treatment-Resistant?
Treatment-resistant depression is, on its face, very straightforward. It is depression that is not affected by traditional means, methods, and modalities. However, many people with treatment-resistant depression give up on their treatment “before the miracle happens.”
The key is to keep trying different modalities and combinations of modalities until something starts to work. It is also important to be willing to stop a treatment and try something new when that previous treatment is not working. Of course, this process can only happen when the treatment is individualized and comprehensive, which is what healing at the cellular level is all about.
Healing at the Cellular Level When Depression Is Treatment-Resistant
Healing at the cellular level is all about focusing on every aspect of the “Self” – the physical, mental, emotional, and spiritual. Many people who have depression that is treatment-resistant fail to find a recovery center that offers this type of comprehensive care.
The fact of the matter is that the recovery realm is a billion-dollar industry and this unfortunately means that there are a lot of bad actors when it comes to treatment. These are recovery centers that are more focused on their bottom line than they are on their client’s well-being.
Generally, these are recovery centers that only offer “cookie cutter” one-size-fits-all” treatment plans. Not only is this going to fail to help a large portion of the population, but it certainly isn’t going to work for individuals who have depression that is treatment-resistant.
Even the primary definitions of treatment-resistant depression show that one-note recovery plans rarely work. According to the peer-reviewed journal World Psychiatry, “The definition of TRD [treatment-resistant depression] adopted by the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) is failure to respond to two or more antidepressant regimens despite adequate dose and duration and adherence to treatment. These regulatory agencies recognize the lack of precision of this definition and its overlap with definitions of ‘partial response’ to antidepressant treatment. The EMA definition, contrary to the FDA one, explicitly states that the failed antidepressants can be from the same or different mechanistic classes.”
So the key is multiple modalities. These multiple modalities (the multi-angled approach) are also the best way to get to the essential underlying issues of treatment-resistant depression.
Getting to the Underlying Issues When Depression Is Treatment-Resistant
It’s critical to get to the underlying issues of any mental illness and/or addiction. This is often where the root/core causes of one’s mental illness reside, including treatment-resistant depression.
However, how can one get to these underlying issues? One of the best ways to do so is via psychotherapies like cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT).
Psychotherapies for When Depression Is Treatment-Resistant
Now, many people may be skeptical of psychotherapies for depression that are treatment resistant, but it is not about just the administering of psychotherapies, it is about how they are used in tandem with other modalities.
Many people only treat depression that is treatment-resistant with two modalities. One is medication like antidepressants. Two is with psychotherapy. Here at Exclusive Hawaii Rehab, we feel that this does not go far enough. Also, we have found that with the right combination of therapies alongside psychotherapies like CBT and DBT, medication may not even be needed (of course, this is a case-by-case basis).
DBT can be particularly beneficial because it focuses on the depth of emotional turmoil that often accompanies treatment-resistant depression. It also helps an individual see how their negative views of themself and the world around them contribute to their depression. Another highly effective psychotherapy for treatment-resistant depression is ketamine-assisted psychotherapy.
Ketamine-Assisted Psychotherapy for When Depression Is Treatment-Resistant
Ketamine alone is not the answer to healing at the cellular level. It must be ketamine administered alongside psychotherapy.
According to the Journal of Pain Research, “One possible aid in prolonging ketamine’s effects is psychotherapy. Psychotherapy describes the treatment of psychological disorders or symptoms through the promotion of personal growth, symptom management, and well-being and is based on therapeutic structures, principles, and techniques. Separately, both psychotherapy and pharmacotherapy have shown equal efficacy, while the combination of both approaches has been found to be more effective in the treatment of psychological disorders than psychotherapy and pharmacotherapy alone; specifically, in certain populations including older adults and patients with comorbid medical disorders.” It is also specific to treatment-resistant depression.
Ketamine-assisted psychotherapy has shown efficacy in treating depression that is treatment-resistant and it continues to show promise. According to the peer-reviewed journal Current Neuropharmacology, “At least 10-20% of the patients suffering from depression meet criteria for treatment-resistant depression (TRD). In the last decades, an important role of glutamate in mood modulation has been hypothesized and ketamine, a non noncompetitive antagonist of the N-methyl-D-aspartate (NMDA) receptors, has been demonstrated to be effective in both MDD and TRD.” However, as previously mentioned even ketamine-assisted psychotherapy should not be used as a sole modality.
Experiential Therapies for When Depression Is Treatment-Resistant
There are many highly effective experiential therapies that can help with mental illness and addiction. This includes helping individuals struggling with depression that is treatment-resistant. Nature immersion therapy is one of the most effective types of experiential therapy, and there may be no better place to participate in nature immersion therapy than on the Hamkua Coast of Hawaii’s Big Island.
Hawaii’s Big Island is known for its majestic waterfalls, amazing overlooks, beautiful beaches, and even a live volcano. Here one can utilize nature immersion therapy to both connect to nature and better connect to themselves. Of course, land is not the only place where one can experience the amazing bounty of nature that Hawaii’s Big Island has to offer.
The Pacific Ocean off of the Hamakua Coast is home to some of the most amazing sea creatures around. This includes local tropical fish and green sea turtles that one can even swim with. One can also meditate atop a surfboard as these majestic creatures swim below.
A mere 15-minute journey from our luxury 30-acre property at Exclusive Hawaii Rehab sits one of the best surf breaks in Hawaii. Here one can participate in the experiential therapy that is surf therapy.
Surf therapy offers a myriad of benefits, which is true of many water-based exercises (like boogie boarding which we offer). According to the peer-reviewed journal Frontiers in Psychology, “It is well-established that regular physical activity can enhance mood and alleviate mental health issues. Aerobic exercises such as jogging, swimming, cycling, walking, surfing, and dancing have all been shown to reduce symptoms of anxiety and depression, improve mood, and lessen cognitive decline.” Yoga is also a physical activity that can greatly help with treatment-resistant depression.
Holistic Healing Methods for When Depression Is Treatment-Resistant
According to the renowned yogi and spiritual teacher B.K.S. Iyengar, “Health is a state of complete harmony of the body, mind, and spirit. When one is free from physical disabilities and mental distractions, the gates of the soul open.” This is symbolic of what yoga has to offer.
Yoga has been practiced for thousands of years. Originally it was solely used as a religious or spiritual practice but it has since moved into the realm of recovery. There are many reasons for this, but the primary one is that it offers so many physical, mental, emotional, and spiritual benefits. It can truly help one to heal from treatment-resistant depression at the cellular level.
The benefits of yoga are vast and varied. According to the International Journal of Yoga (IJOY), “Therapeutic yoga is defined as the application of yoga postures and practice to the treatment of health conditions. Yoga therapy involves instruction in yogic practices and teachings to prevent reduce or alleviate structural, physiological, emotional, and spiritual pain, suffering, or limitations. Yogic practices enhance muscular strength and body flexibility, promote and improve respiratory and cardiovascular function, promote recovery from and treatment of addiction, reduce stress, anxiety, depression, and chronic pain, improve sleep patterns, and enhance overall well-being and quality of life.”
Ultimately, the key to treating depression that is treatment-resistant is to find a plethora of means, methods, and modalities and start experimenting with them all. Some will work and others won’t, but taking the multi-angled approach is the best way to create a combination that is successful.
Healing at the Cellular Level With Exclusive Hawaii Rehab
Thich Nhat Hanh also famously said, “Hope is important because it can make the present moment less difficult to bear. If we believe that tomorrow will be better, we can bear a hardship today.” Here at Exclusive Hawaii Rehab, hope is paramount. We know that with that hope comes recovery.
Here at Exclusive Hawaii Rehab, we believe in long-term success over short-term consequences. That is why we offer individualized and comprehensive recovery plans with a focus on the future. We know that, with our help, recovery is not only possible but with the right effort and action, probable. It’s time to heal at the cellular level, and it’s time to get back to living.