What is treatment-resistant depression?
Treatment-resistant depression is a major depressive disorder that happens when depression doesn’t get better with first-line medications or treatments. Your doctor may diagnose you with treatment-resistant depression if you’ve tried at least two antidepressant medications but haven’t seen an improvement in your symptoms.
While treatment-resistant depression doesn’t always respond to common depression medications, that doesn’t mean help isn’t out there. If you have treatment-resistant depression, you still have several different options to find relief.
How common is treatment-resistant depression?
Treatment-resistant depression is common, and it happens in many people—including those from a wide range of ages, backgrounds and risk factors. It’s estimated that nearly 1 in 3 people with major depressive disorder have treatment-resistant depression.
What are the symptoms of treatment-resistant depression?
The symptoms of treatment-resistant depression include many of the same symptoms of depression. But your symptoms may be more severe, last longer or happen more frequently. If you have this type of major depressive disorder, you may be more likely to also have anxiety or thoughts of suicide.
Talk to your doctor if you have multiple depression symptoms that aren’t getting better or are only partially managed with medications:
- Feelings of sadness, hopelessness, guilt or worthlessness
- Loss of interest in activities or hobbies
- Constant fatigue or low energy
- Loss of appetite or an increase in appetite
- Trouble sleeping or sleeping too much
- Difficulty concentrating
- Thoughts about death or suicide
What causes treatment-resistant depression?
Scientists and doctors don’t fully know the causes behind treatment-resistant depression. But there are some factors they think may lead to a higher chance of any depression happening—such as environmental factors, other health conditions or family history.
For example, changes in your body due to chronic stress could lead to a higher chance of depression and may make depression harder to treat. Depression in women may be affected by changes experienced during the menstrual cycle, pregnancy or menopause, so there could be a hormonal link. Depression could also run in families, though a specific gene hasn’t been found to confirm that.
How is treatment-resistant depression diagnosed?
In most cases, treatment-resistant depression is diagnosed after you’ve tried at least two antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs), without improvement in your symptoms. Typically, you’ll take an antidepressant for six to eight weeks before evaluating how well it’s working.
To help with a diagnosis, your doctor may review factors such as:
- Your original depression diagnosis and if another diagnosis might be more accurate
- Current medications, including over-the-counter medications and supplements, to make sure that you’re taking the right dose and that nothing is interfering with the effectiveness of your antidepressant
- Other medical conditions that might affect how well your depression treatment works
- Lifestyle choices such as substance use
Treatment-resistant depression treatment
Care for treatment-resistant depression is different for every person. What works for one person may not work for you, so a personalized approach to your care is important. Together with your care team, you may need to try a few different treatment plans before you find the right one for your specific needs.
Treatment for the condition often involves using multiple methods as part of your care plan. You may try different medications, therapy-based treatments or medical procedures.
Psychological counseling
Psychological counseling involves visiting a psychiatrist, psychologist or other professional for therapy. Psychotherapy provides strategies or behavioral changes that help you manage your symptoms. It also educates you on ways to cope with factors such as stress, relationships, past trauma or substance abuse.
- Cognitive behavioral therapy: This therapy approach focuses on how thoughts and feelings affect mood. By recognizing negative thoughts or patterns in your thinking, you can take steps to reframe them more positively.
Medication
With treatment-resistant depression, your care team may start by adjusting the dose of your current medication or switching to a different class of drugs. Along with traditional antidepressants, you may also add esketamine for a period of time.
Esketamine is a nasal spray that’s used under the supervision of a doctor in the office, and can improve the antidepressant response of other treatments.
Procedures
If medications and psychotherapy aren’t effective, you may choose to have a procedure to help with treatment-resistant depression. These procedures use magnetic or electrical stimulation to affect activity in specific areas of the brain.
- Transcranial magnetic stimulation (TMS): Transcranial magnetic stimulation is a non-invasive treatment that uses a brief but powerful magnetic pulse to stimulate the areas of the brain that control mood. Treatments last about 15 minutes, and patients receive 36 treatments over seven weeks.
- Electroconvulsive therapy (ECT): ECT uses an electric current to cause a controlled seizure while you are fully asleep under anesthesia. Electrically produced seizures have been used in the US for 80 years and are still one of the most effective interventions for depression. Most people have this therapy three times a week for four to five weeks
Treatment-resistant depression self-care
Talk to your care team about lifestyle changes or other steps you can take to support your well-being and increase the success of your treatment. Small steps to improve your overall health can help you cope better and feel more in control.
- Exercise regularly: From sports to walking to gardening, find ways to include movement in your day. Regular exercise has been shown to improve your mood and reduce stress.
- Eating well: Boost your well-being by making swaps in your diet to focus on healthier foods and drinking enough fluids.
- Get quality sleep: Not getting enough sleep or poor-quality sleep can make depression worse. Ask your doctor about sleep habits or other support to get a good night’s rest.
- Socializing and relationships: Focus on investing time in positive relationships and setting healthy boundaries with relationships that may bring you down. Healthy social interaction can improve feelings of isolation and loneliness.
- Manage stress: Chronic stress could worsen your depression. Find relaxation and stress-reduction techniques that work for you—such as yoga, meditation or journaling.
Find specialized care for treatment-resistant depression
As a part of the Temple Mental Health Clinic, Baylor Scott & White Treatment-Resistant Depression Clinic is dedicated to caring for depression that has failed to improve despite treatment. Located on the campus of Baylor Scott & White Medical Center – Temple, this clinic offers a team of providers who will work with you to find relief from depression.
Learn more about our Treatment-Resistant Depression Clinic in Temple