Combatting the Chronic and Episodic Nature of Major Depressive Disorder
About the Author Dr. Steven P. Levine is a board-certified psychiatrist internationally recognized for his contributions to advancements in mental health care. Though he is a psychiatrist who places great emphasis on the importance of psychotherapy, medication is often a necessary component of treatment, and he was dissatisfied with the relatively ineffective available options with burdensome side effects. Dr. Levine pioneered a protocol for the clinical use of ketamine infusions, has directly supervised many thousands of infusions and has helped establish similar programs across the country and around the world.
“Laugh, and the world laughs with you; weep, and you weep alone.” This quote from Ella Wheeler Wilcox portrays the plight of those suffering from chronic depressive symptoms and episodes of severe depression relapse.
Such patients continue to swallow another pill, meet another mental health professional, and endure another hospitalization with the dimmest of hopes that the next breakthrough may stop the endless nightmare and chronic pain. For some, there is no hope of recovery from treatment-resistant depression — just a sense of guilt, an obligation to someone else, or some unexplainable drive to continue living every day.
There is Hope from Treatment-Resistant Depression
Now, imagine there is a medicine that can almost instantly lift that depressed mood. The tears dry up and the patient feels a sense of awakening and clarity. It sounds wonderful, but when one looks around, one sees with new eyes the surrounding devastation and the casualties from an incapacity to do anything about the growing problems. Then, the patient feels completely overwhelmed by the herculean tasks ahead, sending the patient into a whirlwind of emotions and into depression relapse.
This is one unintended consequence of more effective, fast-acting antidepressants. For the first time in 50 years, novel therapeutics that may offer relief to patients suffering from chronic refractory illness depression are being developed. One such agent is intravenous ketamine, but over the past several years of administering it to those with treatment-resistant depression, I have seen depression relapse borne out many times.
Does this mean patients with chronic refractory illness should not bother getting well if there’s a chance of depression relapse? Of course not, as it is possible to rebuild one’s life even under extraordinary circumstances. However, the seeming impossibility of problem-solving is akin to a poorly prepared survivor of a nuclear apocalypse stepping out of his bunker into a lonely world of destruction.
Cognitive Behavioral Therapy can Prevent Depression Relapse
The potential for this rude awakening calls for some preparation and forewarning on the part of those administering mental health providers administering these rapid-acting tools. It is important to set the expectation that even good change is stressful (marriages, moving homes, new jobs, and the birth of children are some of life’s most stressful events) and that decreasing depressive symptoms is only the first step in a long path towards building a life that feels meaningful.
Regardless of whether a treatment involves ketamine infusions or the next fast-acting antidepressant in the pipeline, “take 2 of these and call me in the morning” is not sufficient to prevent depression relapse. Even a “magic bullet” leaves a wound that requires a period of recovery. This requires support. That support may come from family, friends, community, church, or peers who have experienced similar struggles. In many cases, continuing cognitive behavioral therapy is the best form of support.
Therapists may be helpful with setting short-term goals, teaching new skills to challenge and combat depressive thoughts, and working towards achieving successes that help rebuild self-esteem. It is very difficult to set goals without being able to picture a positive outcome, so having an external guide to help shape and execute a plan may help overcome the initial hurdles. Some of these goals could include lifestyle changes like healthy eating, exercise, and engaging in meaningful activities that can lead to new resilience that protects against the return of depression and feeling sad.
Many with depression wonder, “What will I do if this treatment doesn’t work?”. An equally important question may be, “What will I do if it does?”.
Additional information on ketamine therapy is available.