Dealing With Treatment-Resistant Depression

Woman in Counseling - NIMH

Not everyone who is treated for depression gets relief. 10% to 20% of depression patients have no relief at all from symptoms after multiple treatments. As many as 2/3 of depression sufferers will go through several courses of treatment before they find relief from their symptoms.

Treatment – Resistant depression (TRD) is also known as treatment-refractory depression. TRD is generally defined as major depressive disorder that is not responsive to several courses of treatment – anywhere from two to four different antidepressants from different classes.

Causes of TRD

The reasons for TRD are many. Sometimes it happens when prescribed antidepressants cause side effects that the patient cannot tolerate. Other times it is the result of not taking medications properly, either skipping doses or not taking prescribed dosages.

For some, the initial diagnosis of depression is incorrect. There can be physical disorders that can cause symptoms that mimic – or worsen – depression. Drug or alcohol abuse can accompany or exacerbate depression. It is even possible that a different mental disorder exists, such as bipolar disorder or chronic dysthymia. For all of these, antidepressants may not be effective.

Strategies for Treatment

If you feel you have TRD there are steps you can take. First, rule out misdiagnosis and any physical issues that could mimic depression. See your physician, and make certain that any medications you are taking are not causing your depressive symptoms. Ask your doctor to check your nutritional levels, as deficiencies in some vitamins (D, B12, and folate) and minerals (magnesium, calcium) can cause depressive symptoms.

Next, speak with your mental health professional. Discuss your treatment plan to date, and your expectations for future care. Don’t give up and accept your depression as normal; it isn’t. You and your mental health professional should reconsider the prescriptions you are taking and possibly come up with a combination of medications. Remember that it takes as long as six weeks for your prescribed medications to become fully effective. You might also consider including talk therapy in your treatment plan; the combination of the two tends to improve outcomes. There are a variety of counseling types available, and it might mean that you will need to try more than one before you find the best option for your care.

If medications and talk therapy are not causing remission of your depression, then other types of treatment should be considered. Electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS) and vagus nerve stimulation (VNS) are all available therapies with histories of success. Consult a psychiatrist to discuss the appropriateness and availability of these treatments.

Finally, keep yourself as healthy as you can. Eat a balanced diet, try to get regular exercise and make every effort to get enough sleep. These might all be difficult if your depression is deep, but try to maintain as regular a schedule as you can manage.

Most importantly, don’t give up!

Sources: WebMD and Mayo Clinic

Image courtesy NIMH


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