Treatment-Resistant Depression: Your Continuum of Care
Medications for Treatment-Resistant Depression continued...
Of course, one of the things your doctor might need to do is get you off some of the medications you're on now. If you've been struggling with treatment-resistant depression for a long time, you might have accumulated a lot of different prescriptions over the years. Some of those drugs might not have any purpose. Others might be interacting with each other, or even worsening your symptoms.
When you're trying a new drug for treatment-resistant depression, make sure to give it a fair chance. Cook says that many people who think they are treatment-resistant -- because they've tried a number of antidepressants without success -- might not be. Instead, they just weren't on the medicine long enough to know one way or another. Side effects are often the reason.
"One of the drawbacks to virtually all of the antidepressants is that the benefits come late and the side effects come immediately," Cook tells WebMD. However, he says that if you can stick with a medication for a couple of weeks, those side effects often resolve themselves.
Psychotherapy for Treatment-Resistant Depression
Along with medications, talk therapy -- like cognitive-behavioral, psychodynamic, and interpersonal therapy -- is one of the first approaches that a person with treatment-resistant depression might try.
Research has shown that therapy can help with treatment-resistant depression specifically. The best evidence is with cognitive-behavioral therapy (CBT), which encourages people to see how their own thoughts and behaviors contribute to their depression. One study looked at people who didn't get better using an antidepressant. Researchers found that switching to CBT improved symptoms by 50%. Talk therapy took longer to have an effect, but in the long run was just as effective as trying a different medication.
MacKinnon believes that the concrete focus of cognitive-behavioral therapy can be especially helpful for people struggling with treatment-resistant depression. Approaches that delve into your past and deeper emotional issues might not work as well right now, he says.
"When you're in the middle of a depression, it's really hard to look back at your life and learn from it," MacKinnon says. "Your depression will so distort your perspective that you might come up with the wrong lessons." It might be more productive to engage in that sort of therapy once the depression has lifted, he says.
However, the best therapeutic approach for treatment-resistant depression really depends on what feels right. Keep in mind that many therapists use a combination of approaches. Perhaps the most important thing is to find a therapist whom you like and trust. Having a good partnership is likely to boost your chances of success.