Understanding Treatment-Resistant Depression

Feelings of sadness or hopelessness are a natural part of life. External circumstances will always arise that make you feel unhappy or disappointed. But for those with clinical depression, this heaviness never really stops weighing you down.

Living with chronic depression can be defeating—it makes it feel impossible to get out of bed in the morning, let alone muster up the motivation to complete daily tasks. While some have more severe cases than others, depression can cripple individuals in a way, as it holds back many from fulfilling their goals or even maintaining a stable lifestyle.

Like any illness, mental health disorders are a disease that require treatment and healing. There are several medications that can help to alleviate the symptoms of depression but finding treatment that works can sometimes feel like an uphill battle.

According to the National Institutes of Health (NIH), one-third of adults with major depression battle symptoms that don’t get better with treatment. For a disease that directly affects daily function, experiencing what’s known as treatment-resistant depression compounds this already overwhelming illness.

If you’ve been struggling with treatment-resistant depression, you’re not alone. This post is going to breakdown what treatment-resistant depression is, how to determine if you may have it, and what alternative treatments are out there to help you better manage your symptoms.

How do I know if I have Treatment-Resistant Depression?

Treatment-resistant depression (TRD) refers to your body’s lack of response to at least two antidepressant medications. In other words, if you’ve taken a few different types of antidepressants and haven’t felt any improvements after proper administration, you may have TRD.

Things to pay attention to when trying a new depression treatment:

  • Lack of response to antidepressants or other therapies
  • Increase in severity and longevity of depressive episodes
  • Brief improvements followed by a plateau or return of symptoms
  • Higher levels of anxiety or an anxiety disorder

What’s most important to understand when treating depression with medication is that it takes time to find what works for you. According to NIH, antidepressants don’t improve symptoms for about 10-15 percent of people, while about 30-40 percent notice only a partial improvement in their symptoms. Furthermore, a doctor at UC San Diego Health noted that only 30-35 percent of patients respond to their first antidepressant prescription.

So, while medication can work great for many individuals, it’s rare that your first prescription will be the right one for you. Don’t give up immediately.

In turn, you have to give your treatment an adequate amount of time before determining it doesn’t work. This means staying consistent and following your prescription as directed—no skipping doses or taking a different dosage than prescribed. Most medications recommend taking your prescribed dosage for up to 8-10 weeks before determining its effectiveness.

Be patient with the process and with yourself.

What are the causes of treatment-resistant depression?

Experts have yet to figure out exactly why antidepressants work better for some than others, but they have many theories. Some of the most common explanations include:

Incorrect depression diagnosis

This is the most common theory—that those who don’t respond to antidepressants may not actually have major depressive disorder. They may have some symptoms of depression, but actually have bipolar disorder or another condition with similar symptoms. Talk to your doctor if you believe this may be the case.

Metabolic disorder

Many people process nutrients different than others. A study published in the American Journal of Psychiatry found that some people who don’t respond to depression medication have lower levels of folate in the fluid around their brain and spine. Although, the cause of low folate levels and their relation to TRD is still unclear.

Your Genes

Certain genetic variations can affect how your body breaks down antidepressants, which could make them more or less effective for an individual. While more research is needed for this theory, doctors can run genetic tests to give more insight in determining which specific medication may work best for you.

Your Neurons

A study published in Molecular Psychiatry suggests that a lack of response to antidepressants could have something to do with the shape of your neurons. Essentially, this study found that people who don’t respond to antidepressants tend to have longer neuron projections and lower levels of the two genes involved in making brain circuits.

Other risk factors
  • Individuals who have had depression for a very long time are more susceptible to having TRD.
  • People with either very severe or very mild symptoms are more likely to have TDR. In other words, if you’re on either end of the severity spectrum you may not respond to treatment as well.
  • Those with other mental health or general health conditions along with depression are more likely to experience TDR.

How do I manage my depression if I’m treatment resistant?

Your diagnosis doesn’t make your situation hopeless. While antidepressants can be very life-changing for some, they aren’t the only way to alleviate depression. With a little time and a lot of patience, your doctor can help you find the treatments and coping mechanisms that work best for you.

Some other common depression treatment methods and therapies include:

Clinical Trials for Treatment-Resistant Depression

If you’ve been diagnosed with treatment-resistant depression, sign up to be alerted when a clinical trial is enrolling in your area that might be a good fit for you. We will alert you when we think we have found a clinical trial that may be of interest to you.