For a decade as a young adult, Hannah Wyatt Sultan struggled with depression that debilitated her everyday life.
After many rounds of different antidepressants and therapy, Sultan still wasn’t experiencing remission from the disease — and she was getting frustrated.
“You lose trust in yourself and your own abilities,” Sultan said.
Sultan, as she later learned, had what’s known as treatment-resistant depression, which wasn’t alleviated by antidepressants or psychotherapy. It wasn’t until 2020 that the Denver resident, now 28, was able to land on a treatment — electroconvulsive therapy — that worked for her.
But Sultan is not alone in struggling with treatment-resistant depression — a condition spotlighted by the death last month of country music star Naomi Judd, who had acknowledged she suffered from a severe form of the condition and was an outspoken advocate who tried to shed light on treatment-resistant mental illnesses.
People are considered to have treatment-resistant depression after they’ve tried to treat their depression with at least two or three different antidepressant treatments of sufficient dosage over a period of time without success.
Denver-area experts say there are, in fact, several ways treatment-resistant depression can successfully be treated, including through the electroconvulsive therapy that worked for Sultan.
Dr. Christopher Schneck, the medical director of the Helen and Arthur E. Johnson Depression Center at the University of Colorado’s Anschutz Medical Campus, estimates that 15% to 30% of people suffering with depression encounter treatment resistance. At the same time, 17% of the U.S. population deals with depression during their life, he said.
“We have no way of really knowing which drug is going to work for which person, other than trying medications,” Schneck said.
Sultan continued to seek help and try different treatment paths before she was told about treatment-resistant depression. When a friend in nursing school approached her about trying electroconvulsive therapy, she considered it for a few weeks before meeting with Dr. Konoy Mandal at UCHealth.
The ECT treatment is intense, with patients having to go under general anesthesia as electric currents target specific parts of the brain. Sultan barely remembers her life during the acute period of treatment over the first few weeks.
She was terrified before the first treatment and remained nervous before the next ones, then grew excited as she saw results as soon as a couple of days later.
“I woke up and I was like, ‘Oh my God, I’m actually wide awake and I’m happy right now!’” Sultan said. “I was kind of in awe.”
ECT brought a much-needed change to Sultan’s life that has removed the hurdles that her yearslong depression created.
Mandal and Schneck said that ECT has a success rate of 70% to 80%, but other options are available to those dealing with treatment-resistant depression.
Dr. Eve Langston, an anesthesiologist who started Vitalitas Denver Ketamine Clinic, said that about 70% of people with treatment-resistant depression will see success with ketamine infusion. The anesthetic is infused through IV and if patients respond successfully, treatments continue every three to six weeks, depending on the case.
While ketamine is not approved by the Food and Drug Administration, esketamine, a variation of the drug administered through a nasal spray, is FDA-approved.
Schneck said this distinction is most important when it comes to insurance coverage, given that insurance companies will not typically pay for a treatment not approved by the FDA.
Seeking help for treatment-resistant depression can force patients to rule out more cost-prohibitive options, Schneck said, even though they might otherwise be helpful.
Schneck said that a third approach to alleviating treatment-resistant depression beyond ECT and ketamine is transcranial magnetic stimulation, which uses magnetic fields to stimulate particular parts of the brain to treat depression and other illnesses.
The FDA approved the machine for use with major depression, anxious depression, obsessive-compulsive disorder and cessation of smoking. Schneck said some insurance companies will cover TMS treatments for those conditions, though not any others, which means the treatment would instead have to be paid for out-of-pocket for typically close to $1,000 for the 4- to 6-week-long process.
Schneck’s concerns with costly mental health care reach across the state, as 20% of Coloradans are dealing with a mental health illness, according to the Colorado Behavioral Health Task Force. Additionally, nearly 361,000 residents are uninsured.
Despite the difficulty in access and money, Schneck, Mandal and Sultan said they hope patients will continue to seek treatment until they reach remission, advocating for themselves as they would if they had any other illness.
“It really is just about, amidst the frustration of having depression, not getting frustrated that the things you’re trying aren’t working and not blaming yourself and realizing that it’s not your fault,” Sultan said. “You’ve got to keep going, though.”
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