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When Depression Resists Treatment

It's hard not to feel hopeless when depression treatment doesn't work. But don't give up. As many as two-thirds of people with depression aren't helped by the first antidepressant they try. Work with your doctor to find the best treatments. Depression is highly treatable, and there are many options available. You might find that changing your medication, combining drugs, seeing a specialist, or talking to a therapist helps your recovery and reduces relapses.

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Talk Therapy for Focus and Insight

Talking with a mental health professional can help you set goals, tackle problems, and stay focused on medical treatment for your depression. Talk therapy is an important part of treatment for many people with chronic and treatment-resistant depression (TRD). Ask your doctor to help you find a therapist whom you can work with effectively. Talk therapy includes individual psychotherapy and support groups.

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Therapy That Can Help

Some people may benefit from specific types of therapy. Cognitive-behavioral therapy (CBT) attempts to break down ineffective or destructive patterns of thinking that may contribute to depression. Problem-solving therapy, a type of CBT, may help people with depression cope with negative or stressful life experiences. Interpersonal psychotherapy examines issues like grief, which may affect the relationships between people or cause depression.

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Find the Right Medications

Many people who start taking an antidepressant don’t have a complete recovery and may need a change in treatment. You should see some improvement after six weeks. If your antidepressant isn't working, your doctor may change your prescription or increase your dosage, or prescribe other antidepressants or even other types of drugs to go with it. Continue to take it as prescribed, even if you start to feel better.

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Which Antidepressant Is Right?

The most commonly prescribed antidepressants, known as SSRIs and SNRIs, affect the brain chemicals serotonin or both serotonin and norepinephrine, respectively. Your doctor considers side effects, safety, tolerability, and your history of depression when prescribing antidepressants. You may experience mild to severe side effects like dry mouth, nausea, insomnia, sexual problems, changes in blood pressure, or suicidal thoughts from antidepressants. Sometimes side effects go away. If severe side effects persist, talk to your doctor about changing medicines.

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Other Treatments for Depression

If several courses of different antidepressants have failed, you and your doctor might consider other medical treatments that can help treatment-resistant depression. Electroconvulsive therapy uses small electric currents to cause a brief seizure in the brain. A series of treatments over several weeks can help ease symptoms of severe depression. In vagus nerve stimulation, a small pacemaker-like device is surgically implanted under the collarbone that sends electrical signals to the brain through a large nerve that runs up through the neck. Transcranial magnetic stimulation (shown) sends magnetic pulses to the brain to improve mood.

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Pastoral and Spiritual Counseling

Make sure you have enough support from family and friends so you can cope with your depression. Many people find comfort from being part of a spiritual community. If you are religious, talk with your priest, rabbi, minister, or other religious advisor. These people often know you and your family as individuals. And they can help you articulate the things that are important to you. They'll also help you understand your role in the community.

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Volunteer for a Sense of Worth

Depression feeds on isolation. When you separate yourself from the community, your sense of having no value grows stronger. Volunteering is a perfect antidote. It gives you something to do and turns your focus outside yourself. At the same time, it makes you feel good about who you are. Find something you value. Then offer to help.

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Let Your Family Help

Depression is hard on you and your family. But remember, they can't help if you won't let them. If you share your feelings, you won't create a divide between you and those you love. Let them help when they can, and consider couples or family counseling. Let your family know they are important in your life.

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Plan to Feel Better

You don't always do things that make you happy. But planning enjoyable activities for each day can help your treatment. Each afternoon, jot down a list of what you want to do for yourself the next day. Then add what you need to do for others. Review your plan at the end of each day. How did the things you accomplished make you feel?

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Exercise, a Natural Medicine

You may not feel like exercising. But exercise is effective in easing depression. Your body's physical response to exercise actually improves your mood. That's because exercise causes the release of endorphins. These chemicals trigger a positive feeling. It doesn't matter what kind of exercise you do. Just find something you enjoy and start moving.

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Support From Others Who Understand

A support group is made up of people who know what it feels like to be depressed. It helps to know others understand how you feel. Even more important, they can share coping techniques from their own experience. Plus you have the opportunity to share your successes with them. Ask your doctor to help you find a support group in your area.

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Sources | Medically Reviewed on 07/05/2016 Reviewed by Jennifer Robinson, MD on July 05, 2016

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REFERENCES:

American Academy of Family Physicians: "Practical Management of Treatment-Resistant Depression," "Antidepressants: Medicine for Depression."
WebMD Medical Reference: "Treatment-Resistant Depression."
Mental Health America: "Dealing with Treatment-Resistant Depression: What to Do When Treatment Doesn't Seem to Work," "What to Do When Depression Enters a Relationship."
WebMD Medical Reference: "Exercise and Depression."
MedlinePlus Medical Encyclopedia: "Depression," "Major Depression."
National Institute of Mental Health: "How is Depression Detected and Treated?," "Mental Health Medications."
University of Michigan Depression Center: "Treatment-Resistant Depression," "Interpersonal Psychotherapy for Depression."
National Alliance on Mental Illness: "Cognitive-Behavioral Therapy."
American Psychological Association Publications: "Problem-Solving Therapy."
Markowitz, J., and Weissman, M. World Psychiatry, October 2004; 3(3): pp 136-139.
Consumer Reports Health: "The Antidepressants: Treating Depression (Comparing Effectiveness, Safety and Price)."
Depression and Bipolar Support Alliance: "Treatment Technologies for Mood Disorders."

Reviewed by Jennifer Robinson, MD on July 05, 2016

This tool does not provide medical advice. See additional information.

THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.