Treatment-Resistant Depression: Support Options to Help You Heal

It feels like you’ve tried everything. Multiple different types of meds. Maybe even some forms of therapy. Nothing seems to have worked. This is the story of almost 100 million people globally, all struggling with treatment-resistant depression.¹

When treatments for depression aren’t working, it can feel like there’s no hope, and that nothing will help. If this is how it feels for you, know that it can get better. New treatments are being created all the time, and some are specifically tailored to depression that doesn’t respond to traditional treatment approaches.

Below, we explore what treatment-resistant depression is, its symptoms, and the best treatments for treatment-resistant depression, so you can begin to get some answers and find the support you need.

What Is Treatment-Resistant Depression?

Treatment-resistant depression (TRD) is a form of major depressive disorder that doesn’t respond to traditional treatment methods, such as medication.²You’re considered to have TRD if you haven’t seen improvements in your symptoms despite taking at least two different antidepressants over the course of six to eight weeks each.

Often, the first port of call for doctors when someone comes to them with depression is to prescribe a combination of selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs) and therapy. These are typically a doctor’s go-to because the side effects are less severe for many who take them.

However, not all people’s depression symptoms react to these medications. And for some, the symptoms may ease for a while, only to rise up in full force a few months or years later. If this is the case for you, you’re likely asking, “What can I do?”

Well, despite the name suggesting otherwise, treatment-resistant depression can be treated. As each person differs so greatly (and so does their depression), treating treatment-resistant depression requires you to find an approach or set of approaches that work for you as an individual.

Causes of Treatment-Resistant Depression

It’s impossible to say whether one factor causes treatment-resistant depression. Instead, there are many potentially interconnected elements that increase a person’s risk of developing treatment-resistant depression. Some of these are:³

Being an older adult, as this age group may be less responsive to treatment
Lack of economic resources
Being a racial/ethnic minority group member (as depression is more prevalent in specific populations)
Lower functioning levels
High levels of stress
Lack of social support
Non-compliance with treatment
Not staying on prescribed medications for long enough to see the benefit
Skipping doses of medication
Genetic factors influencing the metabolism of medications
Co-occurring health problems (ie: hypothyroidism)
Misuse of drugs and alcohol
Having a co-occurring eating disorder

It’s important to note that the exact risk factors will likely be different for each individual experiencing treatment-resistant depression. So, if none of these risk factors resonate with you, there could be a whole host of other factors at play.

Treatment-Resistant Depression Symptoms

Approximately 30% of people with major depressive disorder struggle with treatment resistance.¹So, TRD manifests in a way that’s characteristic of the signs of depression, including:⁴

Low mood
Lack of energy
Thoughts of suicide
Loss of interest in usual activities
Difficulty concentrating or making decisions
Feeling worthless or experiencing unwarranted guilt
Appetite changes, which could mean eating more or less than usual
Sleep changes, which could include sleeping more or less than usual
Showing changes in movement patterns, for example, moving more slowly than usual or showing restless movements like pacing

The key determiner of whether depression is treatment-resistant is if the symptoms of depression linger even after you have taken multiple antidepressants as directed by your doctor. If this is the case for you, it’s time to talk about treatment options!

Best Treatment for Treatment-Resistant Depression

When you have treatment-resistant depression, it’s easy to feel hopeless – like you’ll always feel how you do now. While it’s normal to feel like this, know that there is a treatment approach for everyone – it’s just a case of finding what works for you.

Treatment for treatment-resistant depression typically involves lifestyle changes and specific therapy approaches. Let’s explore each in more detail:

Lifestyle Changes for Treatment-Resistant Depression

Lifestyle changes, although they may sound frivolous, are a key component of treating depression. By making healthy lifestyle choices, you can improve your mood, boost your energy levels, and build positive self-esteem. Some of the most beneficial lifestyle changes are:

Social Support

Hanging out with friends and family doesn’t sound particularly prescriptive, but research shows time and time again the positive impact of having a supportive community for your mental health. Even getting out into your community and volunteering or helping out your local community can help reduce the symptoms of depression.^5,6

Diet and Exercise

Eating a balanced, nutritious diet and exercising regularly can go a long way to improving your overall well-being.⁷However, we understand that it’s not always easy to stick to these healthy habits when you’re struggling with depression. If you need further guidance, check out our pages: “Exercise and Depression” and “Self-Care Tips for Managing Depression.”

Healthy Stress-Management Strategies

Chronic stress can worsen symptoms of depression, so learning healthy stress-management strategies can combat these. Our group therapy sessions at Mission Connection are particularly useful for learning stress-management techniques, as you can learn these in the presence of people going through similar experiences to you.

Treating Co-Occurring Medical Conditions

Depression doesn’t often appear on its own. You may also struggle with other medical or mental health conditions, such as chronic diseases, heart disease, and anxiety. Research shows that these co-occurring conditions can influence our response to depression treatment. Therefore, ensuring you follow your doctor’s treatment recommendations for these other conditions may benefit you overall.^8,9

Therapy for Treatment-Resistant Depression

The latest research on treatment-resistant depression suggests several treatment approaches that work well when other treatment approaches haven’t worked. These include:

Electroconvulsive Therapy (ECT) for Depression

ECT is a medical treatment that involves a mild electric current being passed through your brain. While ECT is considered the best treatment for treatment-resistant depression, it’s under-used because of its invasiveness. When the current passes through your brain, it causes a short seizure – and while you will be under anesthesia so you won’t feel pain, most hospitals don’t offer the procedure. Instead, they opt for less invasive methods, such as transcranial magnetic stimulation.²

Transcranial Magnetic Stimulation (TMS) for Treatment-Resistant Depression

TMS has proven to be highly effective at reducing the symptoms of treatment-resistant depression in the short term. However, in the long term, it doesn’t appear to be as effective as ECT. Nevertheless, it may be the right choice for you – it’s important to talk any option through with a licensed mental health professional or doctor.¹⁰

Cognitive Behavioral Therapy (CBT)

CBT is a one-to-one form of therapy that focuses on current difficulties rather than past problems (as is the case with many traditional therapy practices). Your therapist will support you in learning new coping strategies for how to manage your current difficulties, using a range of therapeutic techniques. Research shows that CBT is extremely effective for depression, and in fact, shows more promise than antidepressant treatment in the short and long term.¹¹

Interpersonal Therapy (IPT)

IPT focuses on the connection between your mood and relationships, which can help you resolve any relationship issues that may be impacting your depression symptoms.¹²

Mindfulness-Based Therapy

This therapy approach helps to identify unhealthy, negative thoughts, challenge these, and learn healthier thoughts to replace them, all through mindfulness techniques. It can also help teach valuable skills such as self-compassion. While the research on this approach seems a little hazy, evidence suggests that, when combined with the typical treatment options, it can be highly effective for treatment-resistant depression.¹³

Other effective methods involve switching to another class of antidepressant medication and using therapy in combination with medication.

Can Treatment-Resistant Depression Be Cured?

So, can treatment-resistant depression be cured? While there’s no research to show that any one form of treatment cures treatment-resistant depression, many approaches can go a long way to reducing the symptoms of depression.

You can learn to manage treatment-resistant depression with changes to your treatment regimen. Staying on prescribed medications for long enough (i.e., at least 6-12 weeks) and taking medications for comorbid conditions exactly as prescribed can lead to an improvement in depression symptoms.³Making lifestyle changes, such as building a supportive social network, can also reduce the symptoms of depression.

If you find yourself taking medication and still see no improvement, alternative treatments like TMS can also provide relief.¹⁰So, please trust us when we say that your cause is far from hopeless.

Support for Treatment-Resistant Depression

When you’ve been struggling with depression for a long time and even medications don’t bring relief, it’s normal to feel a little helpless. But know this: there are treatment approaches out there that are right for you; sometimes, it’s just a case of trial and error.

At Mission Connection, we know how frustrating it can be to try different treatments, only for your depression symptoms to stay the same or even worsen. That’s why we offer a range of treatment approaches, so we can find the form of support that’s right for you.

Research shows that certain lifestyle changes and therapies such as CBT, mindfulness-based therapy, and IPT can effectively reduce symptoms of depression, even for people who haven’t responded to other treatments. We have licensed mental health professionals who offer each of these methods within our team, so we can test the waters to see which ones suit you.

What’s more, we offer a range of levels of support, from online therapy so you don’t have to leave your home, right through to intensive inpatient support. So, regardless of the severity of your symptoms and the level of support you need, we can develop a treatment program that works for you.

If you’d like to get started today, give us a call at 866-720-3165.

References

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