The renowned composer Héctor Berlioz’s description of the terrifying sensation of being alone in an empty universe is so vivid that it is hard to imagine for those who have never experienced it. But for many who suffer from acute depression, this sensation is a reality that feels unbearable. Andrew Solomon describes it as both a destruction of the instinctive functions of life and a birth of a demon within oneself.
For some, this “devilish situation” of acute depression persists over time, despite various treatments. So what can be done next? It’s important to first ensure that what the patient is experiencing is indeed treatment-resistant depression. This requires a thorough diagnosis and ruling out other factors such as anemia, hypothyroidism, or other hormonal disorders that could mimic the symptoms of depression.
Once a confirmed diagnosis is made, treatment options must be carefully considered. This might include changing medication to a different family or incorporating various psychotherapy approaches. It’s not exclusively a pharmacological issue; psychotherapy can provide emotional learning and healthy coping mechanisms.
However, it’s also important to widen the focus and consider the patient’s context. Some depressions might be highly conditioned by traumatic childhood experiences, oppressive family relationships, or unbearable work environments.
In some cases, third or fourth-line options such as electroconvulsive therapy or medications with novel mechanisms of action may be considered. While these options have promising effects, they must be handled responsibly and ethically.
The pharmaceutical industry’s contribution of new tools and scientific advances is seen as a positive development in the field of mental health treatment. However, it is important to balance the legitimate interests of pharmaceutical companies with the goal of benefiting society.
For those suffering from treatment-resistant depression, healthcare professionals aim to reassure them that there are numerous options and committed to doing everything in their power to help ease their suffering. The ultimate goal, as expressed by the famous quote by Albert Camus, is to glimpse an “invincible summer” in the middle of winter and not lose hope.