Lauren Terrill, 41, of Baltimore, is one of an estimated 30% of people with depression who have treatment-resistant depression (TRD), which is diagnosed when depressive symptoms do not improve with typical first-line treatments, such as at least two different courses of antidepressants. For those individuals, hope can be found at the outpatient Advanced Depression Treatment (ADepT) Center that serves patients across Maryland.
The ADepT Center is a joint initiative between the University of Maryland School of Medicine and University of Maryland Medical Center (UMMC), the academic medical center of University of Maryland Medical System. This collaboration, which provides the highest level of care for behavioral health disorders, helps Terrill and others with TRD access the support they need.
Open since 2023, the ADepT Center is the only one of its kind in Maryland. There, patients and their psychiatrist or primary care provider can access second opinions and find more effective treatments for TRD.
Jack Vaeth, MD, clinical assistant professor in the Department of Psychiatry at the University of Maryland School of Medicine, is one of the psychiatrists who treats patients at the center. “Previously, we called TRD ‘refractory depression,’ but we now like to refer to it with our patients as ‘difficult-to-treat depression,’” Dr. Vaeth said. “‘Refractory’ and ‘resistant’ suggest red flags with this condition when, instead, the challenges of difficult-to-treat depression might only require a yellow flag of caution. We have hope.”
So does Terrill. She walked a long road to find it.
Frustrating Journey
Terrill views her mother’s 2008 death from cancer as a turning point for her mental health. “Prior to my mom’s passing, I dealt with periods of being depressed because of issues with her health, among other things going on in my life, but the depression wasn’t chronic,” she said. “My mom’s passing was a major blow because of how close I was with her.”
Two years later, Terrill was diagnosed with major depressive disorder and generalized anxiety. At various times over the next decade, she experienced feelings of hopelessness, struggled to get out of bed and had suicidal thoughts. Over the years, Terrill took medications for depression, worked with psychiatrists, attended inpatient and outpatient treatment programs, and tried transcranial magnetic stimulation (TMS), a noninvasive treatment that activates areas of the brain involved in depression. Still, the disorder maintained a firm grip.
“Even before finishing TMS, I hit a low point because it hadn’t helped in a significant way,” Terrill said. “When my psychiatrist brought up the ADepT Center, I felt like she was proactively trying to help me. Now, since I’ve been going to the center, I know I have a group of mental health professionals around me who care.”
For Terrill, her personalized treatment plan and the unwavering attention she receives from the entire team are what set the ADepT Center apart. “From the front desk staff to the nurses to the physicians, everyone is invested in seeing me get better,” Terrill said. “I love being able to meet with the physicians regularly. It’s one more indication that I’m not alone. A team of experts is working together and with my psychiatrist to do everything they can to help me.”
All Together Now
Dr. Vaeth believes the ADepT Center’s unique design helps both patients and their medical providers. “With our consultation and follow-up, we provide another set of eyes with a different angle and a fresh perspective,” he said. “This second opinion can be an invaluable resource during times when hope and optimism wear thin.”
The process at ADepT begins with an initial patient evaluation and consultation with their referring provider to agree on a treatment approach. Next, the ADepT team implements the treatment. Options include brain stimulation therapies, such as TMS and electroconvulsive therapy, individual or group talk therapy, and advanced medications for depression.
Terrill began using one of those medications, esketamine nasal spray, in May at the direction of an ADepT Center psychiatrist. She receives the medication once a week, under the supervision of the ADepT Center staff and meets with a psychiatrist at every appointment.
Small And Meaningful Victories
All patients respond differently to treatment, which is another reason for the ADepT Center’s personalized approach, with some seeing dramatic improvements of up to 80%. Esketamine helped Terrill feel better— progress she hopes to build on. “I hope that as I continue these treatments, I see incremental change,” she said. “It’s been a while since I’ve worked full-time. I won’t be able to jump into a full-time job right away, but working part-time is a near-term goal.”
In addition to esketamine treatment, Terrill continues to take an antidepressant and see her UMMC psychiatrist, Marissa Flaherty, MD, both of which she finds valuable. “We encourage patients to continue to follow up with their referring medical provider,” Dr. Vaeth said. “As a result of our consultative process, we form a new care team: the patient, their referring medical provider and the ADepT team.”
As she works to get life back into a routine, Terrill urges others to be proactive about seeking mental health care. “I know how difficult it is when you’ve tried various medications and are still struggling,” she said. “If a treatment you haven’t attempted is available and may be able to help you, it’s worth it to try.”
Could You Spot the Signs of Depression?
Some depression symptoms are subtle and easy to miss. Others are more obvious. Not all involve mood. You may have depression if you experience symptoms most of the time for at least two weeks. Symptoms to watch for include:
- A hopeless or negative outlook on life
- Avoidance of favorite activities
- Changes to your appetite
- Difficulty remembering information, focusing on tasks or making decisions
- Feelings of frustration or irritation that occur for seemingly no reason
- Feelings of guilt or worthlessness
- Feelings of sadness or emptiness that won’t go away
- Lack of energy
- Physical symptoms, such as headaches or stomach discomfort
- Suicidal thoughts
- Trouble falling asleep, sleeping too much or not enough
- Unexpected weight gain or loss
Self-Care Steps
For Lauren Terrill, and many other people with depression, managing the disorder involves more than one form of medical treatment. Self-care also plays an important role. If you have depression, you can complement your treatment by adopting healthy habits at home, including:
- Eat whole (not processed) foods rich in vitamins, minerals, and fiber, which can support mental health.
- Move your body, which can release endorphins—chemicals that improve your mood—and prompt the release of proteins that fuel brain-boosting nerve connections.
- Prioritize tasks, complete the most important ones first and let the others wait until you feel like getting to them.
- Resume a favorite activity or two—it may be tough at first, but your mood will benefit.
- Set a sleep schedule—go to bed and get up at the same times each day.
- Talk regularly with close family and friends and be open about your feelings.
More to Read
- The Connection Between Not Getting Enough Sleep and Mental Health
- What’s the Link Between Stroke and Depression?
- Are You Experiencing Situational Depression?
- Guided Meditation: A Daily Exercise to Reduce the Stress, Anxiety, and Depression in Your Life
- How Long-Term Stress Affects Your Body — and How You Can Fight Back
If you are working with a health care provider to treat your depression, but it hasn’t improved, ask about a referral to the ADepT Center or call 410-328-8415 to schedule a consultation.