Depression is a common and treatable mental health condition. However, not all patients respond adequately to standard antidepressant medications. When someone has tried at least two different classes of antidepressants at appropriate doses and durations, yet symptoms remain largely unchanged, this is called Treatment-Resistant Depression (TRD).
In recent years, medical advances have introduced new treatment options for TRD, including:
- Spravato® (Esketamine nasal spray)
- Repetitive Transcranial Magnetic Stimulation (rTMS)
- Electroconvulsive Therapy (ECT)
1.Spravato® (Esketamine Nasal Spray)
Spravato® is the first antidepressant in nearly 30 years with a novel mechanism of action, approved specifically for TRD. Unlike traditional antidepressants that target serotonin or norepinephrine, Spravato® works on the glutamate system.
How it works
- Promotes glutamate release, strengthening synaptic connections between neurons
- Improves brain regions involved in mood regulation and reward systems
- Used together with oral antidepressants for more comprehensive results
Advantages
- Rapid onset: some patients feel improvement within 24 hours
- Suitable for high-risk patients with acute suicidal thoughts
- Offers new hope for patients unresponsive to traditional medications
Disadvantages / Side effects
- Must be administered in a medical facility under supervision, with observation for ~2 hours afterward
- Common side effects: dizziness, nausea, temporary rise in blood pressure, dissociation (feeling detached from reality or self)
- Higher cost
Best suited for
- Adults who have failed at least two antidepressant trials
- Patients with depression and acute suicidal risk (doctor’s evaluation required)
2. Repetitive Transcranial Magnetic Stimulation (rTMS)
rTMS is a non-invasive brain stimulation therapy. It uses magnetic fields applied to the scalp to stimulate specific brain regions (commonly the left prefrontal cortex) to regulate neural activity and improve mood.
How it works
- Magnetic pulses induce mild electrical currents, activating mood-related brain areas
- Repeated stimulation enhances neuroplasticity, reducing depressive symptoms
Advantages
- Non-invasive, no anaesthesia required, patients can resume daily activities immediately
- Few side effects, usually mild scalp discomfort or headache
- No risk of memory impairment
Disadvantages / Limitations
- Requires multiple sessions (typically daily for 4–6 weeks)
- Effectiveness varies; not all patients respond
- Caution in patients with seizure history
Best suited for
- Patients who do not respond well to medication or cannot tolerate side effects
- Those seeking non-drug treatment options
3. Electroconvulsive Therapy (ECT)
ECT is a well-established and highly effective treatment for severe depression, especially when accompanied by psychotic symptoms or high suicide risk.
How it works
- Performed under general anaesthesia
- A brief electrical current induces a controlled seizure
- Restores balance of neurotransmitters and promotes neural network reorganization
Advantages
- Rapid and significant improvement, often life-saving in severe cases
- Can be used in pregnancy (with close monitoring) and in patients unable to take medications
Disadvantages / Side effects
- Requires anaesthesia; patients need rest on treatment days
- Common side effects: temporary memory loss, headache, muscle soreness
- Public stigma and misconceptions may reduce acceptance
Best suited for
- Severe depression with psychotic features
- Patients unresponsive to medications and other therapies
- High-risk cases with suicidal intent or refusal to eat
Psychiatrist’s Advice
- Personalized care: Every patient’s condition, health status, and lifestyle needs are unique. Treatment must be tailored individually.
- Safety monitoring: Whether Spravato®, rTMS, or ECT, all require supervision by a professional medical team.
- Integrated treatment: Combining medication, psychotherapy, and lifestyle adjustments yields the best outcomes.
- Ongoing follow-up: Even after improvement, regular check-ups are essential to prevent relapse.
For patients with treatment-resistant depression, new therapies such as Spravato®, rTMS, and ECT provide hope and effective alternatives. With professional guidance and comprehensive care, recovery is possible.
