In such cases, Dr. Aaronson explained, it makes sense to treat patients as though they were displaying full symptoms. “If you see a patient and think ‘this may be bipolar or this may be psychosis,’ you’re better off rounding up than rounding down,” Dr. Aaronson said. “If you’re wrong, you may have more side effects from medication, but an advantage – or disadvantage – of patients with TRD is they’ve already failed six different antidepressants.”
After navigating through the gray zone with a patient, choosing the right medication can be just as onerous. Most antidepressant medications target serotonin, norepinephrine, or, in some capacity, dopamine. Such targets are extremely limiting, because they ignore other neurotransmitters related to mood disorders, Dr. Aaronson said.
The promise of remission is another limiting aspect of treatment. Patients may be better suited if psychiatrists shifted away from the search for a cure and toward helping patients manage their symptoms to give them the best life they can lead, Dr. Aaronson said.
Having a candid discussion about the realistic possibility of remission, as well as encouraging a more healthy lifestyle, can be extremely helpful for patients with treatment-resistant depression.