How to treat treatment-resistant depression: ECT, talk therapy, psychedelics

“It’s very important to make clear that ‘treatment-resistant’ doesn’t mean you aren’t treatable, but that your depression is simply refractory to treatment,” meaning it is not responding, Adli says.

He says about a third of patients with major depressive disorders don’t respond to initial treatment with two antidepressants.

Cognitive behavioural therapy, a deceptively simple mental health tool

Should standard treatment methods fail to improve a patient’s depression, doctors move on to a clearly specified step-by-step plan – and even look beyond it – until improvement is achieved.

Possible options are set down in guidelines for the medicinal and psychotherapeutic treatment of depression. They include electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS).

ECT involves a brief electrical stimulation of the brain, under general anaesthesia, that induces a cerebral seizure lasting about a minute. This causes electrical and chemical changes in the brain.

In rTMS, a magnetic coil placed against the patient’s scalp delivers magnetic pulses to stimulate brain areas that regulate mood.

While both are proven methods of brain stimulation, less evidence has been gathered to date on the effectiveness of rTMS in improving TRD symptoms.

Dr Andrea Jungaberle, a Berlin-based clinical specialist in anaesthesia and emergency medicine, is also a psychedelic therapist who researches the therapeutic application of altered states of consciousness – including for depression. She says it’s important that doctors and TRD patients together seek further treatment options.

In recent years, esketamine nasal spray has been approved in some places for short-term, emergency treatment of severe depression as well as TRD.

How psychedelics like magic mushrooms could treat depression and addiction

Dr Gerhard Gründer, a professor of psychiatry and director of the Department of Molecular Neuroimaging at the Central Institute of Mental Health (ZI) in Mannheim, Germany, heads a study on the antidepressant effects of psilocybin, a hallucinogenic substance obtained from certain types of “magic” mushrooms.

As Gründer emphasises, the method is not comparable to a self-experiment with drugs. “Truffles containing psilocybin are legal in the Netherlands, where you can purchase them in shops,” he says. “But taking a substance like this is by no means a treatment, which must be well prepared and subsequently evaluated.”

How magic mushrooms rewire brains, easing depression and PTSD

Adli underscores the importance of only taking hallucinogenic substances under medical supervision.

“After taking them, some people have dissociative experiences,” he says. “The feeling, for example, that they’re floating through the room, that colours or sound intensities change.

“Some people don’t find this at all unpleasant. Others do. And some don’t notice anything at all.”

As Gründer explains, clinical trials of alternative treatments such as this are aimed at determining their safety and effectiveness for possible approval by regulatory authorities.

“The euphoria needs to be dampened a bit. In the media – in some articles anyway – psychedelics are touted as a panacea,” he says, pointing out that a large number of effective antidepressants are already available.

“At the end of the day, psychedelics are simply a very practical – and probably promising – addition to our treatment arsenal.”

When it comes to research on the use of psychedelic drugs for medical purposes, Germany, according to Jungaberle, is an international laggard.

Research has been going on considerably longer in Switzerland, and there are studies in Great Britain, the Netherlands and Czech Republic, she says.

Magic mushrooms helping with PTSD and depression at psychedelic retreats

“Germany has now jumped on the bandwagon, thank God, but we’re about five to 10 years behind.”

“We need to develop new antidepressants, and further develop existing ones,” says Adli. “Depression is a very common illness. A particular antidepressant won’t help everyone, and more treatment options mean greater treatability.”