Resistant depressive disorder.
We speak of resistant depression when depression does not respond to the usual treatment strategies, there is an insufficient response despite the use of an appropriate pharmacological strategy. Despite pharmacological advances, there are still many patients who do not respond to antidepressant treatment or respond only partially.
Before reaching the conclusion that a depression is resistant to treatment, attempts are made to cure cases of major depression with different methods and medications.
Depression is a major health problem that affects about 300 million people in the world and causes enormous morbidity and disability as well as increased risk of mortality by suicide.
In depressive patients who meet resistance criteria there is: greater affectation by the disease with more important functional affectation, greater morbidity and increased economic costs, higher incidences of suicide attempts and completed suicide.
Alternatives:
In resistant depression, combining psychotherapy with antidepressant treatment is a well-supported approach, as it improves remission rates and reduces relapse and recurrence in the long term. Recommended at all points in treatment. The therapist's experience, the type of psychotherapy used, treatment compliance and the number of sessions are the main variables to take into account. The psychotherapeutic orientations that have been studied in combined trials in the treatment of depression are cognitive behavioral therapy, interpersonal psychotherapy and, to a lesser extent, psychodynamic psychotherapy.
Transcranial magnetic stimulation, the goal is to apply repetitive stimulations to modulate cortical activity and stimulate the area of the brain associated with mood regulation. It has been used as an alternative for depression. Unlike the latter, it does not require anesthesia and is painless to conscious patients.
La ketamina is a drug classified as a dissociative anesthetic that is commonly used in surgical procedures. Promising results have been obtained with robust and rapid antidepressant efficacy, within the first hour post administration and up to 7 days thereafter. Side effects observed with ketamine application are headache, dizziness, dissociation, increased blood pressure, nausea, sedation. Fortunately, these effects are transient and resolve spontaneously within an hour of the procedure.
Esketamine nasal spray is used to control treatment-resistant depression (depression that does not improve with treatment). It is also used with another antidepressant, by mouth, to treat depressive symptoms in adults with major depressive disorder (MDD) and suicidal thoughts or actions. Esketamine belongs to a class of drugs called NMDA receptor antagonists. It works by changing the activity of certain natural substances in the brain. Esketamine must be used in a medical facility under the supervision of health care professionals.
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