Outpatient therapies now offered locally target treatment-resistant depression

Sep. 29—Antidepressants and counseling are the most common ways for people to alleviate their depression symptoms. But for those who experience a form known as treatment-resistant depression (TRD), standard remedies provide little to no relief.

This affects up to one-third of adults with major depression symptoms, such as persistent feelings of sadness, sleep disturbances, low energy and thoughts of death or suicide, research shows.

For those with TRD, the Brattleboro Retreat and Dartmouth-Hitchcock Medical Center in Lebanon have recently started offering alternative services to help manage depression symptoms.

"I worked personally with a couple of folks that have gone through it, and they, generally, talked about having more energy, able to do more things around the house ... ," said Kurt White, vice president of outpatient services at the Retreat. "That's what we're often hoping for, really, is that functional improvement."

The Retreat began providing transcranial magnetic stimulation (TMS) to its established patients this spring, according to White. Recently — with the kinks of running a new program worked out — he said the psychiatric and substance-use treatment provider expanded the service to the general public.

TMS is a noninvasive outpatient procedure that uses magnetic fields to stimulate nerve cells in the brain to improve depression symptoms. It was approved by the Food and Drug Administration in 2008.

Using a magnetic plate on the side of the patient's head, the treatment stimulates growth of new neural pathways in areas of the brain that are under or overactive, according to a news release from the Retreat.

TMS is applied five days per week for up to six weeks to strengthen these pathways, helping to improve brain function and mood. The treatment takes between a few minutes and a half hour, depending on the patient.

If needed, White said patients can be retreated for better results.

He noted there are little to no side effects, especially compared to other depression treatments, which can cause weight gain, insomnia, sexual problems and other complications.

Nineteen people have gone through the Retreat's program, with more than 300 treatments done so far, according to White.

Studies have shown nearly two-thirds of TMS patients had either full remission of their depression symptoms or measurable improvement. White noted the treatment leads to a gradual improvement, typically taking a couple weeks to kick in.

"One person was thinking it wasn't really doing anything," he said, "and then they noticed they could get out of bed, go to work, clean the apartment — things they weren't able to do [before]."

Over in Lebanon, Dartmouth Hitchcock Medical Center has been offering TMS and electroconvulsive therapy — another form of treatment that administers electric currents to the brain while under anesthesia — for several years.

Earlier this year, the hospital also started offering a prescription nasal spray for people with TMD.

The FDA-approved spray — often used in tandem with an oral antidepressant — is made up of esketamine, a more potent form of the anesthetic ketamine that can be given in lower doses and, in turn, have fewer side effects and addictive properties.

But, because there is still a risk of drug misuse and other side effects like sedation, the spray must be administered in a clinic or doctor's office, the FDA notes.

Dr. David Eiler, a psychiatrist and medical director of the esketamine clinic at Dartmouth Hitchcock, said patients self-administer the spray under supervision of a health care provider.

Then, he said their vital signs are monitored for at least two hours before they are sent home. Patients are also required to have a driver take them home, Eiler noted.

Patients will undergo two treatments per week for the first month, and if the spray is working well, frequency of the doses will taper off, according to Dartmouth Hitchcock's website.

Data from a clinical trial of the spray show about 70 percent of patients had at least a 50 percent reduction in their symptoms. About half of the patients had complete remission.

Nineteen Dartmouth Hitchcock patients have utilized the treatment to date, and Eiler said it's been a good experience overall.

"One or two patients have had significant side effects that were struggling enough [with] that they impacted treatment — mainly sedation and some sort of lingering cognitive effects ... ," he said. But "we've had dramatic improvement for a number of patients."

White, at the Retreat, noted the Brattleboro facility will soon offer esketamine treatment as well.

Both organizations said people do not have to be a patient in order to utilize their TDS treatments. People should speak with a doctor or therapist to see whether they qualify, and contact their insurance provider to determine coverage.

To contact the Retreat, call 802-258-3700 or visit brattlebororetreat.org/admissions. Dartmouth Hitchcock's psychiatry department can be reached at 650-0625 or at dartmouth-hitchcock.org/psychiatry.

If you or a loved one is struggling with mental health, you are not alone. For immediate mental health assistance, Monadnock Family Services offers 24/7 care to Monadnock Region residents at 357-4400. New Hampshire also offers a similar service at 833-710-6477 or through its hotline at 9-8-8.

If you are experiencing thoughts of suicide or know anyone who is, contact the National Suicide Prevention Lifeline at 1-800-273-8255.

Funding for the Monadnock Region Health Reporting Lab comes from several sources, including The Sentinel and several local businesses and private donors. We continue to seek additional support. The newsroom maintains full editorial control over all content produced by the lab.

Olivia Belanger can be reached at 352-1234, extension 1439, or obelanger@keenesentinel.com. Follow her on Twitter @OBelangerKS.