It’s a place for people who haven’t found relief after years or even decades of medication trials and psychiatric hospitalizations.
They’ve lost interest in previously enjoyed activities. They’ve withdrawn from family and friends.
Many suffer from cognitive impairments. Some have lost touch with reality and hallucinate.
Then they discover the Treatment Resistant Mood Disorders (TRMD) Clinic. TRMD is the largest referral-based clinic in Utah for patients who struggle to find a treatment that works and are looking for alternative solutions. Each year, the TRMD Clinic treats hundreds of patients for disorders including depression and bipolar and schizoaffective disorders.
“They’ve often lost all hope that anything will help them out of their misery, and they are contemplating suicide.”
Daniela Solzbacher, MD, Medical Director for the Treatment Resistant Mood Disorders Clinic
Tailored Modalities
Solzbacher, previously an Ear, Nose, and Throat surgeon, was drawn to interventional psychiatry after she moved to Utah. “I was struck by the immediate effectiveness of neurostimulation treatments,” she says.
Neurostimulation therapies include electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS). Physicians evaluate every TRMD patient to assess the best treatment for their illness.
ECT is basically a controlled seizure while under anesthesia, performed either on an inpatient or outpatient basis. It’s the best option for severe treatment-resistant depression, especially when patients have suicidal thoughts, psychosis, mania, or catatonia. Solzbacher describes ECT as resetting brain function, so it can return to a healthy equilibrium and functionality. ECT works on all the brain’s neurotransmitter systems, but the exact mechanism responsible for its strong effectiveness is still unknown.
If depression is less debilitating but still persists despite trials with several medications, the best choice may be TMS or ketamine infusions. Both are outpatient treatments. Individualized treatment plans include careful evaluation of patient medication to minimize the chance of relapse after neurostimulation.
Integrated Research
The TRMD Clinic benefits from close integration with research. “We’re not only able to offer the gold standard in established treatments, but we also can offer research trials using innovative methods that have shown promising initial results,” says Solzbacher.
Research continuously informs the care the TRMD Clinic provides and eases early adoption of effective new processes and treatments. “Our team of neurostimulation providers and researchers meet on a weekly basis to discuss patient progress and ongoing treatment plans,” Solzbacher adds. “All this ensures we’re providing the highest quality of care available for our patients.”
Improving Perception
Solzbacher says that the negative depiction of neurostimulation by some media has done patients with TRMD a huge disservice. Today’s treatments are extremely safe and very different from the “shock therapy” portrayed in old movies that used high doses of electricity administered without anesthesia. Still, the stigma of undergoing treatment for psychiatric disorders is a serious dilemma.
“Prior to the pandemic, we were one of the few centers in the country that allowed family and close friends into the treatment and recovery rooms for the entire ECT treatment,” says Solzbacher. “That’s made a lot of them direct advocates for our services.”
She believes the size of the program and high success rates also demonstrate to the general public how treatable mental illness is.
“Just last week, a patient reached out to me saying ECT saved her life,” says Solzbacher. “But she was resistant for so long to undergoing this treatment because of its reputation. A lot of work still needs to be done to provide education and improve the perception of these lifesaving treatments in the general public.”
The TRMD Clinic is poised to do that, reducing the stigma of ECT and providing hope to people who once had none.