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Treatment-Resistant Depression

How well is your depression treatment working? Does it help a bit, but you still don't feel as if the darkness has lifted? Perhaps you feel the treatment isn't working at all. If so, you could have treatment-resistant depression, also called refractory depression. 

Unfortunately, depression treatments don't always work. As many as two-thirds of people with depression aren't helped by the first antidepressant they try. Up to a third don't respond to several attempts at treatment.

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Treatment-resistant depression can leave you feeling hopeless and discouraged. Months or even years can go by without any relief. And after the effort it took to get help, it can be demoralizing when you're just not getting better.

But if your depression treatment isn't working, don't give up. Many people can get their treatment-resistant depression under control. You and your doctor just need to find the right approach. This might include different drugs, therapy, and other treatments. If you're still struggling with depression despite treatment, here's what you need to know.

Understanding Treatment-Resistant Depression

What is treatment-resistant depression? Surprisingly, that can be hard to answer. Experts still disagree on what exactly the term means.

Many say that it's a case of depression that doesn't respond to two different antidepressants from different classes. Other experts say that a person needs to try at least four different treatments before depression can be truly considered treatment-resistant.

Of course for you, the exact definition doesn't matter. You just need to ask yourself some basic questions.

  • Has your treatment failed to make you feel better?
  • Has your treatment helped a bit, but you still don’t feel like your old self?
  • Have the side effects of your medication been hard to handle?

If the answer is yes to any of these, you need to see your doctor. Whether or not you actually have treatment-resistant depression, you need expert help.

Treatment-Resistant Depression: Getting Help

Although a primary care doctor can treat depression (research suggests that 60%-65% of antidepressants are prescribed by primary care physicians), it may be best to see a specialist, like a psychiatrist, if you think you may have treatment-resistant depression. It's a good idea to also work with a therapist, like a psychologist or social worker, because the best treatment is often a combination of medicine and therapy.

Treatment-resistant depression can be hard to diagnose. Sometimes, other conditions or problems can cause similar symptoms. So when you meet with your doctor, he or she will want to:

  • Confirm the diagnosis. Some people who apparently have treatment-resistant depression were misdiagnosed. They never had only depression in the first place. Instead, they have conditions like bipolar disorder (where antidepressants may be less effective than in unipolar depression), or problems with drugs or alcohol that can cause depression, or a medical condition (such as hypothyroidism) that can cause symptoms of depression, and may have been getting the wrong treatment. Other people have dysthymia – a low-level, chronic depression – that is distinct from treatment-resistant depression.
  • Make sure you've been using your medicine correctly. Up to half of all people who get prescribed drugs for depression don't take them as recommended. They miss doses or stop taking them because of side effects. Some give up too soon – it can take 4-12 weeks for a medicine to take effect.
  • Check for other causes. Other issues – ranging from thyroid problems to substance abuse – can worsen or cause depression. So can many medicines used to treat common medical problems. Sometimes, switching medicines or treating an underlying condition can resolve a hard-to-treat depression.

You may wonder why some people do so well with the first medication they try, while you continue to suffer. Experts don't really know. But evidence suggests that people who have especially severe depression may also be harder to treat. A long duration of symptoms may also increase the risk – which is one reason it's so crucial to get control of depression symptoms quickly. The longer depression goes on, the harder it may be to control.

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