1. How do you define and diagnose treatment-resistant depression?
Doctors can have different ideas about what "treatment-resistant" means. For most, it means you didn’t feel better after trying at least two antidepressants from different classes, each for quite some time -- about eight weeks at an appropriate dose. Find out how your doctor views the condition and what that means for you and your treatment.
2. How much experience do you have in treating treatment-resistant depression?
If you have treatment-resistant depression, you need to see an expert -- such as a psychiatrist who has helped other people with chronic depression. You could also find a psychologist or social worker, who has worked on behavioral strategies with people who have treatment-resistant depression.
3. Why is my depression hard to treat?
Ask your doctor if there could be a reason why treatments haven't helped you -- you took a previous medicine at too low a dose or for too short a time to see an effect; you have other medical conditions (such as hypothyroidism) or an additional psychiatric problem (such as alcoholism or drug abuse, or an anxiety disorder) that could interfere with treatment for depression. Remember that most antidepressants take six to eight weeks to have an effect. See if there is anything that you can do to help yourself during treatment.
4. Could different medications help with treatment-resistant depression?
Even though the drugs you've tried may not have worked for you, there are always other options. Other medications -- sometimes in different doses or combinations or those used to treat other conditions -- may help with treatment-resistant depression. Review the choices with your doctor, and make sure to ask about the potential side effects.
5. What are other treatment options for treatment-resistant depression?
Find out about the ways your doctor helps people with treatment-resistant depression. Could talk therapy such as cognitive behavioral therapy help? Might ketamine therapy help? Could brain stimulation therapy help relieve the symptoms of depression? Brain stimulation therapy includes electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), vagus nerve stimulation (VNS), and magnetic seizure therapy (MST). Get a good idea of what approaches your doctor might try.
6. How can we make my treatment plan as simple as possible?
The simpler your treatment regimen, the easier it is to stick to it. So, if you're confused about what your doctor wants you to do, ask questions. For instance, what time of day should you take your medication? Does the schedule make sense for your lifestyle? Do you need to take your medicine on a full or empty stomach? Keep in mind that costs -- and your insurance coverage -- might affect the specific drugs your doctor suggests.
7. Could any health conditions or medicines be affecting my depression or interfering with my treatment?
Many health issues - such as heart disease, cancer, thyroid problems, and substance abuse -- can trigger or worsen the symptoms of depression. Some drugs could affect how well your antidepressants work. Make sure your doctor knows your complete medical history and all of the other medications you take -- including supplements and vitamins.
8. Should I consider experimental treatments?
If standard treatments haven't worked, you could consider enrolling in a clinical trial of an experimental treatment. These are approaches or medications being studied in clinical trials but not yet approved by the FDA as depression treatments. Ask your doctor if you might be a good candidate for a clinical trial. Information about research treatment studies for depression can be found at www.clinicaltrials.gov.
9. What changes do I need to make to my lifestyle?
There are many things that you can do on your own to support your treatment and potentially ease your symptoms. Ask your health care provider for recommendations on physical activity, sleep habits, and diet.
10. What should I do in an emergency?
You and your doctor should have an explicit plan for crises. If you are ever in danger of hurting yourself or others, you -- and your family -- need to know what steps to take.