Tackling Treatment-Resistant Depression

By Jeff Ballinger

A Columbia psychiatry program is offering new hope to people who suffer with depression that does not respond to traditional treatments.

Many patients don’t realize they have treatment-resistant depression, says Adrian Jacques H. Ambrose, MD, who, with Joshua Berman, MD, PhD, directs the Treatment-Resistant Depression Program. “Here at Columbia, we consider that if you’ve tried two or more antidepressants and it hasn’t worked for you, you might have treatment-resistant depression.”

Patients with treatment-resistant depression represent a significant portion—estimated between 25% and 50%—of those with a major depressive disorder.

For many people with depression, conventional antidepressants and talk therapy are not enough. By the time patients arrive at Columbia, they have tried multiple pharmacological and non-pharmacological therapies and feel completely hopeless. “They really don’t see how they’re going to get better,” Dr. Berman says.

At Columbia, the clinical team is trained in interventional neurotherapeutic psychiatry, which refers to a collection of advanced psychiatric modalities, including transcranial magnetic stimulation, electro-convulsive therapy, and esketamine and ketamine, that modulate dysfunctional brain circuitry.

Having multiple treatments available under one umbrella better serves patients. “That we’re able to quickly pivot to another modality gives the patient a sense of control back in their life,” Dr. Ambrose says.

The results indicate the approach is working. Dr. Ambrose cited as an example one business executive who had tried over 10 antidepressants, multiple therapists, and even several hospitalizations and ECT, without seeing any improvement. “The patient was feeling hopeless, but after trying a succession of different treatments at our center, we were able to find something that provided real help within four or five months.”

“In many instances, patients will tell us they’ve gotten their lives back,” Dr. Berman says. “As a doctor, you really can’t beat that feeling.”

Learn more about the Treatment-Resistant Depression Program.