Treatment-Resistant Depression: What to Do When Your Meds Don't Work

Oct 21, 2021


Treatment-Resistant Depression (TRD) is depression that has failed to respond to at least two treatments like antidepressant medication and/or therapy. The good news is that there are more medical options to help treat depression than most people realize.

Combating Treatment-Resistant Depression

Have you ever wondered why some people struggle with depression, even after getting therapy or trying medication? Have you or a loved one tried taking anxiety or depression meds but felt that they just didn’t work? You might be experiencing or witnessing Treatment-Resistant Depression. The good news is that there are more options to help treat depression than most people realize.  

What is treatment-resistant depression, or TRD? Depression comes in all types and variations, some types more difficult to treat than others. TRD is a major depressive disorder that describes depression that has failed to respond to at least two different antidepressant treatments. Depression can already feel hopeless and inescapable, and TRD only compounds that problem. This makes it difficult for patients to find any kind of long-lasting relief.

Studies show that one third of adults with major depression struggle with symptoms that don’t get better with treatment. Whether people struggle to find a medication that actually works for them or never respond to any standard antidepressants, the results can be discouraging. Alexander Papp, MD, psychiatrist at UC San Diego Health says that only 30-35 percent of patients respond to the first antidepressant they’re prescribed.

Signs and Symptoms of Treatment-Resistant Depression

The biggest indicator of TRD is that you have tried multiple antidepressants as directed and still show no signs of improvement. According to John H. Krystal, MD, McNeil Professor and Chair of Psychiatry at Yale: “If you haven’t had an adequate response to antidepressant medication by about 10 weeks of treatment with the optimal dose, it’s probably worthwhile to request a change in your treatment plan…This change might involve adding psychotherapy, an additional medication, switching antidepressants, or starting a neurostimulation treatment.”

Things to Pay Attention to:

  • Little to no response to antidepressants and psychotherapy treatments
  • Increasingly severe and longer depressive episodes
  • Brief improvements followed by a return of depression symptoms
  • High anxiety or anxiety disorder

How Can I be Sure it’s Treatment-Resistant Depression?

What makes TRD so tricky to diagnose is how many variables there are to consider. A misdiagnosis can occur because a doctor prescribes the wrong dose of a medication, or perhaps a patient forgets to pack their meds for vacation. People can quit taking their pills altogether. These variables, and many others, can cause someone to think an antidepressant isn’t working when it can be due to minor adjustments. If depression is not treated correctly, it can look like TRD. Here are some surefire ways to know that it’s actually TRD:

  • You have figured out the right antidepressant and dosage. Though the process of finding the right medication can be long and tedious, doctors recommend trying up to four antidepressants from different classes to find the right match.
  • Your other meds aren’t interfering. Additional medications such as blood pressure meds, antibiotics or steroids can play a part in the effectiveness of antidepressants.
  • You have no other underlying health issues. Additional medical problems can cause or worsen depression. Things like hypothyroidism, chronic pain, hormone imbalances, and addiction are likely to stick around no matter what medication you are taking.

How Can You Treat Treatment-Resistant Depression?

Going off its name alone, TRD may sound like it’s untreatable. However, there are options available outside of antidepressants.

  • Ketamine is a drug that quickly produces the effects of an antidepressant by increasing the amount of neurotransmitters in the brain. Because the effects of ketamine are so immediate, it is one of the best methods to provide immediate relief to symptoms of depression.
  • Electroconvulsive therapy (ECT). ECT is an effective treatment for depression, with a response rate of 80-85 percent. During treatment, patients are anaesthetized and given electric stimulation to the brain. This induces brief seizures over a period of several weeks and can have other negative side effects, including memory loss. Because of these side effects, this method, though typically effective, is often recommended as a last resort.
  • Transcranial Magnetic Stimulation (TMS). Occasionally confused with ECT, TMS is a treatment that uses magnetic stimulation rather than electric currents to stimulate the brain. During treatment, a helmet that contains an electromagnetic coil is placed on the patient’s head. Magnetic pulses are then delivered through the coil to stimulate neurons in the area of the brain associated with depression. It is a treatment with no severe systemic side effects and is a safe and effective way to help many people treat their depression, including women that are pregnant. It is covered by many insurance providers and is FDA approved for adults.

Alternative Ways to Combat Treatment-Resistant Depression

Finding ways to combat TRD can be a long and winding journey, but there are coping mechanisms that can help along the way:

  • Do Talk Therapy. There are a multitude of different types of therapy that can be helpful, including cognitive behavioral therapy, mindfulness-based cognitive therapy, or something else altogether. There are plenty of options available in the world of talk therapy, but you will need to find what works best for you.
  • Find ways to relax. Different people have different ways to relieve stress. From yoga class to journaling, or even taking time to practice mindfulness techniques, there are many small and simple ways to help relieve stress.
  • Avoid self-medicating. Drinking and unprescribed drugs can worsen symptoms of depression. They can also lead to a very vicious and hard-to-break cycle of addiction, so these types of coping mechanisms are not recommended.
  • Practice Self-Care. The basics of living well can help. Eating well, getting sleep and exercising can make all the difference in matters of mental and physical health.
  • Don’t give up hope. Finding the best possible treatment for you takes time and effort, but it is always worth it to find the right fit. Be sure to communicate with your doctor about what you’re feeling.

If you or a loved one is struggling with severe depression, then it's time to schedule an appointment with one of the medical professionals at Serenity Mental Health Centers to get the much-needed care that you deserve.

Call us at 844-692-4100 to talk with one of our incredible patient care coordinators that are standing by to help you get on the right track to TAKE BACK YOUR LIFE!