When fall turns to winter, it is common to feel a little flat. Shorter days can leave you sluggish, sleeping longer and less interested in seeing people. For many, that heaviness passes once the days grow longer again. For others, it hangs on through every season, even after trying medication after medication.
Those two experiences can look alike from the outside, but seasonal depression and treatment-resistant depression are not the same thing, and they are not always treated the same way. Below, we walk through what sets them apart, where they overlap, and why ketamine therapy is an option some people with treatment-resistant depression explore.
Seasonal Depression: When Mood Follows the Calendar
Seasonal affective disorder, often shortened to SAD, is depression that follows a yearly pattern. The National Institute of Mental Health notes that it typically lasts around four to five months each year.
The winter pattern is by far the most common. It tends to show up in late fall or early winter and fade by spring. People often notice:
- Oversleeping, or feeling like they can never get enough rest
- Strong cravings for carbs, often with weight gain
- Wanting to stay home and skip things they used to enjoy
- Feeling drained and finding it hard to concentrate
Some people have the reverse: a summer pattern that brings insomnia, a smaller appetite, restlessness and anxiety.
Women are diagnosed with SAD more often, and it is more common the farther you live from the equator, where winter daylight is shortest. Even in the Midlands, where winters are milder, shorter days can still affect mood. Light therapy, counseling and antidepressants are the usual first steps, and they help many people.
When Treatment-Resistant Depression Is the Problem
Treatment-resistant depression, or TRD, describes depression that does not get meaningfully better with standard care. NAMI uses the term when someone has tried at least two antidepressants, each for several months, and is still struggling.
It is far from rare. According to NAMI, roughly 60% of people who begin an antidepressant end up needing more than one medication before they see improvement. Working through options is not a sign that you did something wrong. It usually means your brain may respond better to a different kind of treatment.
The lines between the two can blur. Seasonal symptoms may stop responding to the treatments that used to help, or may not lift when spring arrives. A provider can help you work out which picture fits.
Why Ketamine Is Different for Treatment-Resistant Depression
Most antidepressants act on serotonin and norepinephrine, two of the brain’s chemical messengers, and it can take weeks before you feel a change. Ketamine takes another route. Its main action is on glutamate, though researchers are still working out exactly how it helps, and more than one pathway is likely involved.
What is clear is that its benefits continue well after the medicine has left the body. Research suggests ketamine helps the brain form more synapses, the connections between nerve cells, in certain areas. In the early months of treatment those new connections are not permanent. Whatever led to the loss of connections in the first place is still there, so without ongoing treatment the gains can fade. How long the benefit lasts differs a great deal from one person to the next, and most patients need treatment on a regular schedule for at least their first five to six months.
For some people, ketamine may:
- Bring relief in hours or days rather than weeks
- Work even after other antidepressants have fallen short
- Give a new option to people who feel they have run out of them
Everyone responds differently, and studies on long-term use are still underway. Your provider can help you weigh whether ketamine makes sense for you.
A Typical Ketamine Visit
Ketamine is given in a medical office, and clinical staff stay with you the whole time. Most visits follow these steps:
- Review. Your provider goes over your medical history, the treatments you have tried and what you hope to get out of care.
- Treatment. You settle into a quiet, comfortable room for your treatment while staff keep an eye on your blood pressure and how you feel.
- Rest. You stay until any side effects wear off, which usually takes about two hours or less.
- Getting home. Plan for a friend or family member to drive you, since you cannot drive yourself after a session.
Care usually starts with a series of sessions spread over a few weeks. Your provider will explain what follow-up care may look like for you.
Side Effects and Safety
Like any medicine, ketamine can cause side effects. Johns Hopkins Medicine lists effects such as:
- Dissociation, a feeling of being detached from your body or surroundings
- Upset stomach or sleepiness
- A temporary increase in blood pressure
- Headache or lightheadedness
Most of these pass within a couple of hours. Ketamine is not a fit for everyone. If you have certain heart problems, high blood pressure that is not under control, or a history of substance use, a different treatment may be safer. Sharing your complete medical history with your provider helps them make that call.
Signs It’s Time to Get Help
Consider talking with a provider if:
- You have felt down for longer than two weeks
- Two or more antidepressants have not given you enough relief
- Seasonal symptoms are not improving with treatment or are not easing as the seasons change
- Low mood is getting in the way of work, sleep or relationships
If you are thinking about hurting yourself, call or text 988 now to reach the 988 Suicide & Crisis Lifeline.
Help for Treatment-Resistant Depression in Columbia, SC
Seasonal depression and treatment-resistant depression can feel much the same day to day, yet each may call for a different plan. If the usual treatments have not worked for you, ketamine therapy may be worth a conversation.
Our team at Columbia Ketamine Center can walk you through your options and answer your questions. Schedule a free consultation or call (803) 250-7171.
This post is for general education and is not medical advice. Please talk with your own healthcare provider about your symptoms and treatment choices.