Anxiety disorders and depression are the most common conditions seen at the Emotional and Behavioural Disorders in Adults Clinic, and are currently the cause of many days off work and adaptation problems in individuals who suffer from them. Depression presents a wide variety of symptoms, but it is generally characterised by the presence of low mood, a feeling of emptiness and irritability. Depression leads to negative thoughts, a feeling of desperation and low self-esteem. People who suffer from depression tend to reduce typical behaviours that were previously satisfactory for them. Other symptoms that can appear are:

• Loss of or excess hunger
• Sleep alterations that range from insomnia to sleeping too much
• Difficulty enjoying things that were previously enjoyable
• Tendency towards social isolation
• Lack of energy

The diagnosis and treatment of depression helps people recover their normal life as soon as possible and prevent the feelings of incapacity that accompany the person who suffers from them. Treatment should usually combine a pharmacological approach with psychological support. At Guttmann Barcelona the cognitive-behavioural psychological model is followed.

Resistant depression 

Resistant depression, also known as refractory depression or treatment-resistant major depressive disorder, is a severe form of depression that does not respond adequately to conventional treatments, such as cognitive behavioral therapy or selective serotonin reuptake inhibitors (SSRIs). It affects a significant proportion of individuals suffering from depression, creating a considerable challenge for both mental health professionals and patients.

The diagnosis of resistant depression is made after a patient does not experience significant improvement with at least two different drug treatments, administered in adequate doses for a sufficient time. Resistant depression is also considered when there is no improvement with the combination of psychotherapy and antidepressant medications.

The management of resistant depression involves a comprehensive and multidisciplinary approach. One of the newest and most promising methods in the treatment of resistant depression is transcranial magnetic stimulation (TMS). TMS uses magnetic fields to stimulate specific areas of the brain associated with mood regulation. This approach has shown encouraging results in some patients who do not respond to conventional treatments.

TMS is performed by applying magnetic pulses through a coil placed on the scalp. These pulses induce electrical currents in specific brain regions, which can modulate neuronal activity and positively affect depressive symptoms. Although TMS is generally safe, it should be performed under the supervision of trained professionals.

In addition to TMS, an integrative or multidisciplinary therapeutic approach is essential in the treatment of resistant depression. This approach involves the collaboration of different specialties, such as psychiatry, psychology, social work and occupational therapy. The treatment team can design personalized strategies that address not only depressive symptoms, but also the underlying factors that contribute to treatment resistance. Combination therapy, which includes combining different treatment modalities such as psychotherapy, medications, and emotional self-regulation techniques, is also considered an effective strategy in the management of resistant depression.

In conclusion, resistant depression presents a significant challenge in the field of mental health. Transcranial magnetic stimulation, together with a comprehensive and multidisciplinary therapeutic approach, offers renewed hope for those who do not respond to conventional therapies. It is crucial that healthcare professionals work closely together to provide personalized treatment options and improve the quality of life for those facing this difficult condition.