“When I see new patients with treatment-resistant depression, I tell them that if they want to borrow some of my optimism, they’re welcome to it. . .Despite how it feels, lots of people have been through this and lots of people get better.” – Ian Cook
Major Depression is the most common mental illness affecting over 6% of the population. The first line treatment is antidepressant drugs. But, depression can be difficult to treat. Of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. This leaves a third of all patients treated without success. These patients are deemed to have treatment-resistant depression.
Being depressed and not responding to treatment is a terribly difficult situation. The patients are suffering and nothing appears to work to relieve their intense depression. Suicide becomes a real possibility. So, it is imperative that other treatments be identified that can be applied when the typical treatments fail. In today’s Research News article “Transcranial Magnetic Stimulation, and Depression Specific Yoga and Mindfulness Based Cognitive Therapy in Management of Treatment Resistant Depression: Review and Some Data on Efficacy”
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4609854/
Pradhan and colleagues review the research literature on alternative treatments for treatment-resistant depression; ketamine, transcranial magnetic stimulation, and yoga and mindfulness interventions.
They report that infusion of the drug Ketamine, a glutamate receptor (NMDA) antagonist, has been shown to be effective quickly for treatment-resistant depression. Unfortunately its effects last only about a week and it has some troubling side effects. Another treatment, repetitive transcranial magnetic stimulation (rTMS) stimulates the human cortex through external magnetic stimulation and can be applied non-invasively. It appears to be effective for the relief of treatment-resistant depression in about half of the patients and it has very few and mild side effects. But treatments must be provided on a daily basis in a doctor’s office. So, it is very inconvenient and thereby often impossible for the patients.
Contemplative practices such as meditation and yoga are low cost and generally safe with few if any side effects. They have been shown to be effective for depression and to prevent relapse (see http://contemplative-studies.org/wp/index.php/category/research-news/depression/). A combination of cognitive behavioral therapy with mindfulness and meditation techniques, Mindfulness Based Cognitive Therapy (MBCT) has been demonstrated to be effective for depression even after drugs have failed to relieve the depression (see http://contemplative-studies.org/wp/index.php/2015/07/17/dealing-with-major-depression-when-drugs-fail/).
Pradhan and colleagues perform a pilot study of a combination of MBCT and yoga they term Depression Specific Y-MBCT (DepS Y-MBCT) applied to treatment-resistant depression patients, one third of whom had suicidal tendencies. Of the 32 participants, 27 achieved remission from depression that was maintained for at least two months. These are exciting findings. A low cost and safe therapeutic technique combining mindfulness, yoga, and cognitive behavioral therapy produced and 85% remission rate for patients who did not respond to other treatments. Of course, these results need to be repeated in a randomized clinical trial. But, these results certainly justify the effort.
It is interesting that a disease like depression that is thought to be organically based in defective brain chemistry can be treated by a behavioral treatment. But, yoga and meditation have been found to alter the structure, connectivity, and chemistry of the brain. So, it may not be so mysterious how a behavioral treatment might be effective for a primarily physiological disorder. The mind and body are one. Treating the mind can also treat the body. This is one of the major messages of the alternative medical treatment movement.
So, apply mindfulness when nothing else works for depression.
“Start living right here, in each present moment. When we stop dwelling on the past or worrying about the future, we’re open to rich sources of information we’ve been missing out on—information that can keep us out of the downward spiral and poised for a richer life.” ― Mark Williams
CMCS – Center for Mindfulness and Contemplative Studies