Treatment-Resistant Depression

Are you concerned that your depression is not responding to treatment? You're not alone. Studies report that as many as three out of every 10 patients in primary care with depression do not respond to any of the treatment options they've tried. These men and women may have tried a variety of options, including different types of antidepressants, multiple types of psychotherapy, and other approaches. Yet no treatment seems to work to ease their depression. Additionally, of the 40% who do respond to the first antidepressant they use, one out of every five has to stop taking it because of side effects.

Treatment-resistant depression is also called refractory depression. It can leave you feeling hopeless and frustrated. But if your depression is not responding, don't give up. You still have other treatment options, and working with your doctor is the only way to find the one that works best for you.

Could I have treatment-resistant depression?

This is a hard question to answer. Even experts don't agree on what "treatment-resistant depression" really means. As an example, some doctors might discuss treatment-resistant depression after a single depression medicine fails. But research suggests that up to 70% of people do not fully recover after taking their first course of antidepressants. Other doctors say that true treatment-resistant depression should only apply to people who haven't been helped by at least two different depression treatments, such as medicines, talk therapy, or electroconvulsive therapy (ECT).

Doctors also differ in their sense of what treatment success means. Obviously, if a depression medicine completely resolves your depressed symptoms, it works. But what if the depression medicine only helps a little? Some doctors might call that moderate success. Others would call it a failure.

Because definitions of treatment-resistant depression can be confusing, don't worry about the details. Instead, ask yourself these basic questions to assess your depression and treatment resistance:

• Did your depression treatment not work at all?
• After treatment, do you feel somewhat better but still depressed?
• Did treatment help, but, because the side effects were so bad, you had to stop?
• Did treatment work for a time, but then your symptoms worsened again?
• Do you feel a constant, low-level depression, also known as dysthymia?

If you answered yes to any of these questions, see your doctor. Even if your condition does not meet everyone's definition of treatment resistant depression, you are still depressed. And you and your doctor still need to explore additional treatments.

What factors increase the risk of treatment resistant depression?

Different environmental and biological factors can limit your response to an antidepressant or other depression medication. They include:

• Marriage and relationship problems or a history of neglect or abuse in childhood. These problems may be treated with psychotherapy to improve coping skills and day-to-day functioning.
• Alcohol and/or substance abuse, which can impede recovery with antidepressants alone. A substance abuse counselor and/or support group may be helpful.
• Chronic pain, which can slow down your recovery because of the chronic complications with sleep, activity, stress, and more.