The H.U.B facilitates access to specialised care for treatment-resistant depression

Depression is a common illness. It can affect anybody at any point in their life. In most cases treatment permits a significant improvement. For some people, however, despite adhering strictly to the prescribed treatment the symptoms remain all too present, in the form of tiredness, loss of interest or pleasure, pain, anxiety, despair, etc. We then speak of   treatment-resistant depression.

What is treatment-resistant depression?

This simply means that usual treatment has not helped sufficiently and does not mean that “nothing works”. Treatment-resistant depression is not an incurable illness or in any way inevitable. It is rather a form of recurrent depression that requires other approaches  that are sometimes more intensive or more innovative. 

Professor Pierre Oswald: ”Treatment-resistant depression is not a life sentence. Today we have numerous effective treatment options that can help.”  

Why can depression resist treatment?

Because the depression affects the individual in their entirety:  

• Mood,
• Energy,
• Sleep,
• Concentration,
• Appetite,
• Pain,
• Relationships,
• The way they perceive themselves, their past and their future.

It is therefore logical that no single treatment will always be sufficient. That is why the H.U.B proposes   comprehensive care that acts on the body, the mind and lifestyle.  

What solutions does the H.U.B propose?  

1. Traditional and enhanced medication

There are several groups of antidepressants. When an initial treatment fails to produce sufficient results, the psychiatrist can change the molecule, progressively increase the dose or combine two treatments to boost  effectiveness.  

These adjustments are common and are simply ways of finding the right formula for the right person as we do not all react in the same way.  

In some more severe cases a treatment can be administered by means of an injection or infusion for a more intense action. These procedures are always carried out in a secure environment with support staff present.  

2. Psychological therapies

These therapies play a major role in improving the patient’s condition and preventing a relapse. They do not replace medication but they can be a very effective supplement.  

Here are a few examples:

• Cognitive behavioural therapy (CBT) – This helps to identify negative automatic thoughts (“I am worthless”, “nothing ever changes”) and to replace them with more realistic and reassuring thoughts. It also provides practical tools for taking action in everyday life.  
• Eye movement desensitization and reprocessing (EMDR) – This approach is used when painful memories or traumas sustain the depression. It makes it possible to “desensitize” the emotion associated with these memories so that they cause less pain.
• Psycho-corporal therapies such as relaxation, meditation or hypnosis – These techniques engage the body to calm the mind, reduce rumination, reduce anxiety and help the individual to be present in the moment. They are very useful when the depression is accompanied by stress or fatigue. 

Why are these therapies so important?  

Because they make it possible to act on those symptoms that medicines treat less effectively: guilt, intrusive thoughts, psychological pain, relational difficulties or loss of self confidence.  

3. Physical treatment

In some situations treatment that acts on the brain can be proposed.

Electroconvulsive therapy (ECTY) that is a modern treatment, administered under close medical supervision and that bears no relation to the images you find in certain films.  Here is the reality of ECT:

• It is administered under a general anaesthetic of short duration (as for minor surgery),
• The patient feels nothing, no pain,
• The whole procedure is monitored by a trained and experienced medical team.

ECT is only used in special cases, such as extremely severe depression with a vital risk or when eating has become impossible. In these situations it can be very effective and very rapid and thereby save lives. The psychiatrist always takes the time to explain everything and answer questions. Nothing is done without the patient’s consent. 

4. Work on lifestyle

This is not a question of “giving advice” as lifestyle is an inherent part of the treatment. When sleep or diet are disrupted over a long period, or physical activity is very reduced, the brain itself suffers from the effects and the depression deepens. At the H.U.B teams support patients on the road to improvement:   

• Sleep – Understanding the body’s rhythm, restoring regularity, treating insomnia (unable to get to sleep or waking up often) or hypersomnia (sleeping too much).   
• Diet – Some people lose their appetite while others eat to calm psychological pain. Personalised support makes it possible to avoid deficiencies and to stabilise energy.  
• Physical activity – This improves mood as much as certain drugs and helps relieve anxiety. No performance level is required and just a few minutes’ physical activity a day is enough to start with.  
• Stress management – Breathing, relaxation, total awareness and organisation of everyday life are all tools that make days brighter and avoid relapse. 

A new outpatient consultation dedicated to treatment-resistant depression: rapid and effective access

The H.U.B has opened a specialised consultation providing access to an innovative treatment: esketamine. This treatment acts differently to conventional antidepressants and in 60 % of patients a notable improvement is observed where other treatments have failed.  

Why is this major progress?

• The treatment is reimbursed for episodes of treatment-resistant depression (by the terms of INAMI [National Institute  for Health and Disability Insurance] regulations).
• It requires no hospitalisation: everything takes place as an outpatient, with nursing and medical supervision.
• Once the treatment is validated by a psychiatrist, appointments can be made quickly whereas other Belgian hospitals have very long waiting lists.  
• It is a complementary treatment that supplements usual antidepressants.  

Dr Youssouf Ramdani : “This treatment does not work miracles, but it does give an additional chance to people who are sometimes locked into a suffering that is lasting.”  

Why outpatient treatment?

Because today it is no longer necessary to be hospitalised to benefit from specialised treatment. The aim is to:  

• Propose flexible proximity treatment to people who live in the region,
• To reduce treatment waiting times,
• To ensure continuous monitoring by the usual care staff.

The H.U.B: a place where we care for the entire person

Depression is treated by a team of psychiatrists, psychologists, nurses, sleep specialists, dieticians, algologists, etc. The aim is to ensure that no patient is “shunted around” from one department or hospital to another.  

“Mental and physical health are linked. A person can never be defined solely by their symptoms. Our mission is to support the individual in their entirety,” concludes Professor Pierre Oswald