Depression is among the most common mental health illnesses, affecting nearly seven percent of adults in the United States every year. For some people, depression occurs after a major life event such as moving to a new city, an unwanted job change, losing a loved one, or going through a divorce. For others, it isn’t tied to a specific event and may even be hereditary.
Of those that are treated for depression, about four out of five experience a marked improvement in their symptoms. They begin to engage with their loved ones, enjoy their hobbies, and have the motivation to function effectively at work or school.
While this is encouraging and is a great motivation for someone who’s thinking about seeking treatment for their depression, it also means that about one out of five adults don’t see an improvement in their symptoms.
Depression is extremely debilitating for many who live with it, and summoning the courage and motivation to take the first steps in seeking treatment can be a challenge. For someone who dutifully takes their depression medication and keeps their appointments with their mental healthcare provider but doesn’t experience a break in their symptoms, depression treatment can feel like one more failed experiment. To make matters worse, the longer the depression symptoms persist, the more difficult they are to treat.
What Is Treatment-Resistant Depression?
As its name suggests, “treatment-resistant depression” is a term for depression that is difficult to treat. Decades of research have linked it to several causes, including:
- Long episodes of depression that cause lasting changes to the brain, making it difficult to return to healthy functioning
- Very severe episodes of depression, which are often associated with chemical imbalances
- Old age
- Co-occurring illnesses such as anxiety, substance abuse, and personality disorders
- Whether the individual expects treatment to be effective
Treatment-resistant depression is a term used by mental healthcare professionals, but there’s disagreement over how it’s defined. Some define it as a case of depression that doesn’t respond to at least two different antidepressants from two different classes after six weeks of treatment. Other experts believe that the individual needs to try at least four different treatment regimens before labeling their depression as treatment-resistant.
Most often, though, the label is used by the individual themself after they’ve begun treatment but aren’t benefiting from it. Once someone has decided to seek treatment for depression, their primary goal is to attain mental health as quickly as possible. Unfortunately, because there’s no one-size-fits-all treatment plan, many individuals have to go through trial-and-error periods to determine what works best for them.
Options for Treating Depression
Depression treatment generally consists of a combination of medication and talk therapy.
Medication Options
There are five major classes of antidepressants, each of which works differently and has its own risks, benefits, and appropriate uses. When a doctor is deciding which medication to prescribe, they consider factors such as the individual’s symptoms, their treatment history, and whether they have co-occurring illnesses such as anxiety. If a family member has successfully been treated for depression with medication, the doctor may use that as a starting point.
For an individual who’s taking an antidepressant but isn’t experiencing any symptom relief, there are several options.
- Give the medication more time. Many antidepressants have to build up in the body’s system before they begin to work. In some cases, the individual may not feel the full effect of the medication until two months after they’ve begun taking it.
- Increase the dosage. People respond to medication differently, and some need a higher dose than what is typically prescribed for the medication to work. While increasing the dose may be the key to effective treatment, it’s critical that a person only adjusts their dosage under the direction of their doctor.
- Add another type of antidepressant. By using two or more different antidepressants from different classes, an individual can target a wider range of brain chemicals that affect mood.
- Switch to a different antidepressant. The first antidepressant that an individual tries may not be the most effective for them, and they may need to try several before finding a good fit.
Counseling Options
Depression is a complex illness, and while medication can have a profound impact on the individual’s quality of life, it’s most effective when it’s paired with counseling from a mental health professional. Counseling can help identify the factors that contribute to depression and help the individual find effective coping strategies, deal with emotional trauma, reframe difficult circumstances, and address substance use issues, which often accompany depression.
The most common type of counseling is cognitive-behavioral therapy. CBT helps the individual identify and change unhelpful and unproductive thinking patterns and build skills to deal with stress and conflict in a healthy way. Oftentimes, family, marital, and group counseling or support groups are also incorporated into depression treatment.
Other Treatment Options
Depression treatment options are abundant, and even after someone has tried a few medications, it’s unlikely that they’ve exhausted all the available treatment options. For those who are seeing minimal progress with medication and counseling, neuro-rehabilitative services may be the key to depression treatment.
Neurofeedback training is one option that’s been proven to be effective for many in treating depression. Through this technology, mental health professionals can target certain areas of the brain that are affected by depression, including areas that control things such as judgment, planning, mood regulation, and attention span. Through a system of rewards, neuro-feedback training trains the brain to function normally.
The groundbreaking medication ketamine is another option that has helped many people with treatment-resistant depression. People who are suicidally depressed have often begun to feel better within as little as one or two treatments. (Learn more about ketamine treatment.)
When Antidepressants Don’t Work: Living with Incurable Depression
For the majority of people, a combination of medication, counseling and neuro therapy effectively treats their depression. Other people may experience depression as a cloud that always hovers, no matter what treatments they try.
For the handful of people who truly have treatment-resistant depression, looking for a cure may be the wrong approach. Rather than seeking to totally eliminate every symptom of depression, a more realistic and productive goal may be to learn how to manage the symptoms of depression and achieve the best outcome possible.
Those who haven’t had success in treating depression may benefit from seeking help from an experienced mental healthcare professional. While primary care doctors can prescribe antidepressants, for many people, this is just one aspect of effective treatment. A mental healthcare professional that utilizes more comprehensive treatment plans and has up-to-date knowledge on state-of-the-art therapies may be able to better help individuals achieve their desired outcomes.
Taking the Next Steps
There are several steps that individuals with treatment-resistance depression can take to improve outcomes.
Follow the Treatment Plan
According to one study, about half of unsuccessful depression treatment is due to non-compliance. In some cases, the individual may experience unpleasant side effects from their medications. Alternately, they may stop taking their medication due to financial factors or fears of becoming dependent on it. It’s important that an individual follows their treatment plan. If cost, side effects, or addiction concerns are factors, they should speak with their doctor to discuss their options.
Manage Stress
Stress can worsen depression, and while it may not be possible to completely avoid stressors, there are plenty of stress-reduction techniques that an individual can try. These include guided meditation, mindfulness exercises or yoga.
Get Enough Sleep
It’s easy to downplay the importance of sleep, but the truth is that an individual’s quantity and quality of sleep directly impact their energy level, resilience to stress and overall mood. A doctor or mental health professional can provide advice on improving sleep habits.
Get Regular Exercise
Exercise releases endorphins, the feel-good chemicals that reduce feelings of stress and alleviate depression. Adding exercise to depression treatment can improve its overall effectiveness.
While treatment-resistant depression can feel hopeless, there are steps that an individual can take to enjoy a better quality of life and achieve their treatment goals. By working with a mental healthcare professional who’s experienced in treating depression through a variety of therapies, individuals can enjoy the best treatment outcomes possible.
