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Why treatment for depression is not a one-size-fits-all approach

Finding ways to manage depression varies with each individual. But promising options exist, even for those with severe depression
Multiple risk factors contribute to a person developing depression.

It’s likely that you or someone you know will experience depression. That’s because one in eight Canadians will experience clinical depression at some point in their life.

Unfortunately, a recent survey suggests the prevalence of depression is increasing. In September, Statistics Canada released the results of a study conducted in the spring of 2021 which found that 25 per cent of Canadians aged 18 and older screened positive for symptoms of depression, anxiety or posttraumatic stress disorder (PTSD) – an increase from 20 per cent only a year earlier.

Dr. Diane McIntosh – psychiatrist, educator, and the author of This is Depression – says multiple factors contribute to an individual developing depression. These factors may be biological (for example, genetics or hormones), psychological (a traumatic experience or less effective stress-management skills) or social (stressful life experiences such as bankruptcy, divorce, or loneliness).

“It’s important to recognize that the three groups [of factors] are truly fluid and impact one another,” she says, so there is never just one reason underlying the development of depression.

Causes of depression can be as unique as personality

McIntosh explains that children are born with innate or genetically determined characteristics, known as temperament. Temperament reflects our unique personal level of intensity or excitability, and influences how we interact with the world around us. Personality, on the other hand, is shaped by our life experiences, such as how we are parented, our friendships and education experiences, and the culture we grow up in.

“Our level of resiliency or vulnerability to stress is related to our temperament and our personality,” says McIntosh. And because temperament and personality – as well as exposure to other risk factors – can vary greatly from person to person, that means an individual’s experience of depression is as unique as they are.

“Depression looks and feels different for every individual,” says McIntosh. “It’s so much more than a diagnosis, a bad childhood, genetics, a drug, or a therapy. And the support required to fully recover must be tailored for every individual.”

Antidepressants can be an effective treatment for depression, but every antidepressant doesn’t work for every person. McIntosh says that the right medication for someone is one that addresses all of their symptoms, not just a few of them, and that people shouldn’t settle for medications with intolerable side effects.

For some people experiencing depression, antidepressants are not fully effective. For others, they are not effective at all. The most challenging depression diagnoses are often referred to as treatment-resistant depression (TRD). McIntosh notes that, “While there is no universally agreed-upon definition of TRD, Canadian psychiatrists usually diagnose TRD when a patient has tried two or more antidepressants at therapeutic doses and their depression symptoms have not improved.”

The promising potential of rTMS and esketamine

There are, however, reasons to be hopeful. Two treatment options have shown significant promise for people living with TRD as well as those who don’t tolerate or fully respond to antidepressant treatment.

rTMS (Repetitive Transcranial Magnetic Stimulation) is a non-invasive procedure carried out in a clinic by a medical professional. A lesser-known but increasingly more available treatment option for moderately-severe depression, rTMS uses magnetic pulses to stimulate targeted areas of the brain that are involved in mood regulation.

The second treatment option is esketamine, a completely new option derived from the anesthetic ketamine, which works by changing the activity of certain natural substances in the brain. Esketamine is administered through a nasal spray, under close medical supervision, in a safe and comfortable setting. Both rTMS and esketamine treatments are currently available through the mental health team at TELUS Health Care Centres in Vancouver.

The importance of a holistic approach

With so many potential factors that can cause depression in the first place, there’s no one-size-fits-all solution when it comes to treatment, according to McIntosh. Since the root causes of depression are as unique as the individual experiencing it, a personalized treatment plan is essential. Depending on the severity of depression and an individual’s preference, such a plan might include talk therapy, exercise, a healthy diet and/or medication.

Since depression is commonly linked with physical health, McIntosh notes that a holistic approach is important.

“Properly assessing and treating a mental illness should include considering an individual’s physical health as well,” she says. “While help can take many forms, a qualified professional is the best person to diagnose and create a treatment plan for depression based on a person’s unique needs.”

To speak with someone on the TELUS Health mental health team, call 1-866-937-3892 or click here to learn more.