Major depressive disorder (MDD), a common and serious mental disorder that negatively affects how people feel, think, act, and perceive the world, impacts millions of individuals across the globe, often significantly influencing their quality of life and functionality.
However, transformative advancements in mental health care are offering new hope to those trying to manage this condition. Beyond standard antidepressants and psychotherapy, novel treatment modalities are delivering promising results for patients. These innovative approaches, grounded in cutting-edge research, are opening doors to effective, personalized care that targets depression from fresh and dynamic perspectives, offering hope to patients who might feel as though they have tried every available treatment without success.
Traditional Treatments
It’s important to note that there are traditional interventions, such as psychopharmacology and psychotherapy, that can work to treat major depressive disorder. The distinguishing factor, however, is that in a majority of patients, those tactics don’t produce remission from depression.
Fortunately, there’s an emerging class of things to consider from a treatment perspective for people who haven’t responded maximally to the more traditional options. This is called treatment-resistant depression (TRD), also known as difficult-to-treat depression, which is a severe form of depression that is insufficiently treated using standard interventions.
Hightop Health specializes in providing comprehensive care for TRD by employing integrative treatment approaches featuring progressive, contemporary therapies. These innovative treatments target persistent depressive symptoms, offering new hope and potentially significant relief to patients who have not found success with conventional medications and psychotherapy. By utilizing cutting-edge techniques and personalized care plans, Hightop Health is dedicated to improving the quality of life for patients facing this challenging condition.
Transformative Treatments
The initial phase of TRD treatment must start with an audit of previous treatments tried and the individual patient’s responses to each. In many circumstances, traditional treatments for MDD may not have been effective because they didn’t meet criteria for an adequate trial. An adequate trial means that an evidence-based intervention was done correctly at the right dose for the right amount of time and that the patient adhered with treatment recommendations. For example, if a prescriber recommended an evidence-based antidepressant medication at a dose below the minimal therapeutic dose that has been shown to be effective in clinical research trials, that would not constitute an adequate trial of that medication. If a patient took the medication only 50% of the days prescribed, that non-adherence to timing would mean it was not an adequate trial of the medication. A thorough assessment of prior treatments by a skilled expert clinician is the necessary initial component of TRD treatment, and may reveal that additional maneuvers using traditional interventions such as a trial of another medication or a specific type of psychotherapy may be a prudent choice for patients who initially believed they have TRD.
In a similar vein, another essential component of an initial TRD assessment is to rule out underlying physical medical issues that may be contributing or causing difficulty in treating the depressive symptoms. Frequently, laboratory tests, a physical examination, and maybe even head imaging, sleep studies, or other consultations with other medical specialists are required for this purpose. Many patients are surprised to learn that physical medical problems like low thyroid, some autoimmune diseases and even electrolyte abnormalities can mimic TRD. It is much easier to prescribe thyroid replacement medication for someone with low thyroid than it is to complete TRD interventions, so ensuring that such medical variables are expertly assessed is a necessary component of a TRD work-up.
For those who haven’t experienced improvements through adequate trials of conventional methods and who don’t seem to have underlying physical medical problems that explain their suboptimal response to traditional treatments for depression, innovative and potentially transformative therapies are offering new hope. Advanced treatments in mental health care are reshaping the way we approach depression by targeting the brain in novel and possibly revolutionary ways.
SPRAVATO® is a newly patented form of a psychedelic medication called ketamine that is delivered as a nasal spray. Approved by the Food and Drug Administration (FDA), it is theorized that this intranasal therapy targets N-methyl-D-aspartate (NMDA) receptors in the brain, offering a different mechanism than traditional antidepressants, which typically focus on the neurotransmitters serotonin, dopamine, and norepinephrine.
While its non-invasive administration via a nasal spray provides convenience and comfort, SPRAVATO® should always be administered in a clinical setting under strict medical supervision, ensuring safety and efficacy.
At Hightop Health, we monitor our patients closely due to potential side effects, which may include increased blood pressure, fast heart rate, and temporary dissociative symptoms. This supervision ensures patient safety and comfort throughout the treatment sessions.
Patients may prefer this FDA-approved approach, as it ensures a regulated and standardized treatment, often covered by insurance, making it more accessible for individuals with TRD.
Ketamine therapy, while not currently FDA-approved for the treatment of any mental illness, has been shown in research studies to be beneficial for certain patients who have not responded ideally to traditional interventions. This dissociative anesthetic is administered via intramuscular injection (IM) or intravenous (IV) infusion, and once again, needs to be performed in a controlled, private clinical setting under strict medical supervision to ensure maximum safety and efficacy.
At Hightop Health, our clinicians carefully assess each individual to determine who may be candidates for ketamine infusion therapy before integrating it into a treatment plan. An important component of the assessment process for patients who elect to try ketamine treatment is education about the potential risks and benefits of this novel treatment modality. Whether provided through Ketamine-Assisted Psychotherapy (KAP) Services, or as a standalone treatment (Ketamine-Only Therapy Services), all of Hightop Health’s ketamine services are provided in our clinics to ensure safety, appropriate monitoring of patients, and to prevent possible misuse of the agent which some people abuse recreationally in the community
The experience generally unfolds over 60 minutes, with additional time for recovery and ongoing monitoring after administration.
Transcranial Magnetic Stimulation (TMS)
TMS is an FDA-approved, non-invasive procedure that is believed to stimulate underactive areas of the brain associated with depression and other mental health conditions. Benefits include its non-invasive nature, minimal side effects, and the ability to stimulate brain areas – and possibly dampen down other brain regions which are thought to be overactive in certain mental illnesses — which can lead to improved depression symptoms without the need for anesthesia or recovery time.
At Hightop Health, we use the NeuroStar TMS system, which gently places a magnetic coil against the patient’s scalp. This coil delivers targeted magnetic pulses to carefully targeted brain areas implicated in depression. These pulses are similar in strength to those used in MRI machines, penetrating the skull to reach specific brain regions like the prefrontal cortex. By stimulating these areas, TMS helps modulate brain activity and may alleviate symptoms of depression in some patients who haven’t responded to more traditional therapies.
Our patients typically undergo TMS therapy five times a week for four to six weeks, with sessions lasting between 30 to 40 minutes. The treatment is conducted in a comfortable environment where patients remain seated and relaxed. Monitoring for adverse reactions is imperative so that the strength of the TMS pulses can be tailored to each individual and patients can be monitored for any potential adverse reactions to the treatment. . Due to its non-invasive nature, patients can resume daily activities immediately after treatment, including driving, working or going to school, and all other daily activities of living.
Intensive Outpatient Program (IOP)
Another, often underutilized, strategy for combating major depressive disorder is engaging in an Intensive Outpatient Program, which is an immersive experience, providing comprehensive mental health care in a community-based setting. Unlike inpatient programs that require patients to reside at a facility, an IOP allows patients to maintain their daily routines while receiving intensive treatment. This flexibility is essential for those who need structured support but cannot commit to full-time hospitalization.
Learning different coping strategies and mechanisms to control the way people think, behave, and feel using cognitive behavioral therapy (CBT) is incredibly useful. However, there is also a potential rapid disintegration of the utility of those new ideas, unless you practice them in real-life situations.
Practicing new scenarios in the real world, called in vivo situations, is the best way to hardwire the changes that people learn from cognitive behavioral therapy into the fabric of who they are as a human being.
IOPs afford people the option and opportunity to practice CBT skills in real-world situations, by bringing people who suffer from depression and anxiety together, to work through the best way to change the course of their lives in a more positive way. By implementing both individual and group therapy sessions, patients learn similar coping strategies and different skills to control automatic negative thoughts, for example, and then as a group, practice those news skills with one another. Peers are able to provide feedback for one another and expert therapists serve as coaches for continual improvement in the identification and application of more effective coping strategies.
What happens outside of treatment is also equally as important. When patients go home for the evening or go back to work one day, it’s vital they can come back to a safe environment where they can share what tactics were successful and what things they need to continue to work on improving. Receiving feedback from other patients who are learning the same skills and experiencing similar emotions is extremely beneficial, and perhaps even more impactful than hearing similar messages from professionals who may not have first-hand experiences similar to what that individual is managing in their life.
In addition to the repetitive immersion experience in CBT therapy, a multi-pronged treatment approach affords IOP patients diverse strategies to maximize resiliency and lasting mental and physical health.. Trusted and experienced IOPs should also include programming that involves Lifestyle Medicine interventions such as working with a licensed dietician to specify and maximize the mental health benefits of a healthy diet, a personal exercise trainer who can help leverage physical activity and movement to improve certain aspects of anxiety and depression, as well as an expert in guided mindfulness meditation which has been shown to be beneficial for almost everyone!
A thorough medical assessment and lab work is another component that should be included as well. There are so many physical illnesses that can mimic symptoms of depression, but aren’t major depressive disorder, which is why it’s pertinent to work with a pundit medical professional to ensure a proper diagnosis.
Oftentimes, those are very important augmentations for a treatment plan that get ignored or left by the wayside. And at the end of the day, the hallmark of a successful Intensive Outpatient Program is capitalizing on peer support, integrating real-world experiences, and implementing dietary and physiological adjustments in order to be able to continue to develop better ways of doing things – across the board/spectrum. That’s why Hightop Health prides itself on its commitment to a comprehensive approach to mental health care.
As the saying goes, the proof that IOP is helpful for many patients with TRD is in the proverbial pudding. Hightop’s clinical outcomes program routinely measures progress toward patients’ goals with recurrent, validated psychometric tests that quantify changes in symptoms, functionality, social relations, quality of life, and even hope for the future. Data are shared with patients and their support systems throughout treatment so that a patient’s “team” has information to modify and improve interventions to maximize treatment benefits. We believe that data should drive decisions and integrate both subjective and objective data in ongoing treatment planning.
Careful Of Cure-All Covenants
These innovative approaches, grounded in cutting-edge research, are opening doors to more effective, personalized care that targets depression from fresh and dynamic perspectives. And while these transformative advancements in mental health care are offering new hope to those trying to manage their depression, it’s important to note that like all interventions, they are not a panacea. In most cases, patients will need to continue pharmacological, psychotherapeutic, and lifestyle changes while receiving those treatments. Some patients will also require “boosters” along the way, perhaps having less frequent TMS, ketamine, or SPRAVATO® sessions while incorporating other changes into their lives. Hightop clinicians will help every individual patient develop a long-lasting plan to try to maintain improvements and prevent relapse.
That’s why it’s so important to go to a clinic, like Hightop Health, that centralizes all of these interventional therapies, so all aspects can be monitored concurrently. It’s an amalgamation of treatments that is most effective.
At Hightop Health, we provide state-of-the-art care that embodies compassion and hope throughout a patient’s journey with us. Our clinics, which are independently owned and operated physician practices, are renowned for their commitment to excellence, managing each location with a foundation built on integrity and empathy.
Our holistic approach ensures patients receive personalized treatment tailored to their unique needs. We integrate various services, where appropriate, into our comprehensive and individualized treatment plans, making it an effective solution for many—particularly patients with major depressive disorder.
At the end of the day, what’s most important for those individuals is finding a mental health care provider that is reputable, knowledgeable, and experienced.
If you have any questions regarding effective MDD or TRD treatment options for you or someone you care about, please feel free to contact us today—we’re always here to help.