If you are struggling with depression, you may feel alone, hopeless, and lost. You may have tried different treatments such as therapy, medication, or lifestyle changes but still feel like your depression is not improving. This can be frustrating and overwhelming, but you are not alone.
Treatment-resistant depression (TRD), which we call difficult-to-treat depression, is a common condition where people do not respond to traditional antidepressant medications. It can leave people feeling stuck in a cycle of hopelessness and despair. However, there is hope for those suffering from hard-to-treat depression.
What Is Treatment-Resistant Depression?
Treatment-resistant depression refers to a type of depression that does not respond adequately to standard treatments, such as antidepressants or talk therapy. This can happen even after trying multiple medications or therapeutic approaches. While it’s not uncommon for people with depression to require adjustments to their treatment plan, TRD occurs when traditional methods fail to provide adequate relief.
Signs of treatment-resistant depression include:
- Unresponsiveness to at least two depression medications
- Persistent feelings of sadness or hopelessness despite treatment
- Difficulty functioning in daily life, such as at work or in relationships
- Lack of energy, motivation, or interest in activities you once enjoyed
- Recurring thoughts of worthlessness or self-doubt
How Prevalent is Treatment-Resistant Depression?
It’s estimated that about 30% of people diagnosed with major depressive disorder (MDD) are resistant to typical treatments.1 However, it’s also likely that many of these cases are actually “pseudo-resistant,” meaning that the person either didn’t stick to their treatment regimen or they received inadequate care.
This is why it’s so important to seek mental healthcare from experienced, knowledgeable professionals explicitly trained in hard-to-treat depression. They can help you explore all your options, ranging from changing therapy approaches and more appropriate medications to alternative treatments like TMS and Spravato®.
Why Does Depression Sometimes Resist Treatment?
Depression is a complex condition influenced by various factors, including brain chemistry, genetics, environment, and overall health. The reasons why someone may develop treatment-resistant depression are equally diverse and can include:
- Incorrect diagnosis: Sometimes, other mental health conditions, like bipolar disorder or anxiety, may mimic depression symptoms, complicating treatment.
- Genetic & biological factors: Each person’s unique genetics influences how effective medication can be.
- Underlying medical conditions: Chronic illnesses, hormonal imbalances, or nutritional deficiencies can impact depression treatment.
- Medication ineffectiveness: Not all antidepressants work the same way for everyone. What works for one person may not work for another.
- Unaddressed trauma or stress: Emotional or psychological stressors, if not fully explored, can limit the effectiveness of standard therapies.
Managing Difficult-to-Treat Depression
TRD doesn’t mean your depression is untreatable; it simply means that a different or more specialized approach may be needed to address your unique needs. This could include changing your medication or trying an alternative treatment such as Spravato® or TMS.
Spravato® (Esketamine)
Spravato® is an FDA-approved treatment specifically for adults with treatment-resistant depression. It’s a nasal spray that targets glutamate, a neurotransmitter in the brain responsible for regulating mood and emotions. This unique mechanism of action sets it apart from other antidepressants, which primarily affect serotonin or dopamine levels.
Unlike traditional antidepressants, which can take weeks to show effects, Spravato® works rapidly, often providing noticeable improvement within days.
Here’s what to expect when starting Spravato® treatment:
- Administered in a clinical setting: Spravato® is given under the supervision of a healthcare professional in a comfortable and monitored space, with two hours of monitoring after administration.
- Fast results: Many clients report feeling relief from symptoms after hours or days.
- Part of a comprehensive plan: Spravato® is often used in conjunction with an oral antidepressant to maximize effectiveness.
Transcranial Magnetic Stimulation (TMS)
TMS is an innovative treatment option for people with treatment-resistant depression, using magnetic fields to boost brain function.
Here’s how TMS works:
- Non-invasive, outpatient procedure: TMS is administered in an outpatient session that lasts somewhere between 20-40 minutes. People can drive and return to work after their sessions.
- Targets neural areas underactive due to depression: TMS uses magnetic fields to stimulate nerve cells in specific areas of the brain associated with mood regulation, particularly the prefrontal cortex.
- Few side effects: The most common side effects are a small headache or slight pain at the procedure sight, which typically resolve within a day at most.
Changing Medications
A psychiatric provider who specializes in difficult-to-treat depression may suggest you try a new medication or add another on top of your current plan. It’s important to share with your prescriber any persistent symptoms or side effects you experience so they can continue adjusting your regimen as needed.
You should also tell your psychiatric provider about any family history of depression and which medications worked for these family members. This can help identify new routes for medication to try.
Can Therapy Still Help with Difficult-to-Treat Depression?
Yes, it’s a good idea to stay in therapy, even if you don’t find immediate relief from your depressive symptoms. It’s important to talk to your therapist about any concerns you have about your current sessions, what’s working, and what could be improved.
Your therapist’s job is to help you, so they want you to be open and honest with them. If you don’t think your therapist’s approach is helpful, it’s worth sharing that with them. They may change course or provide you with a referral to a different clinician. Our New Directions Mental Health clinics staff a large number of therapists with different specialties and approaches, and our team can help you find the right fit if you’re not making progress with your current therapist.
Additionally, if your care team adds TMS or Spravato® to your treatment plan, you might be surprised at how this can improve your therapy sessions. Both TMS and Spravato® increase the brain’s plasticity, meaning you may experience new insights and openness.
It’s important to stick to all elements of your care plan. Depression recovery can often feel like a long road, so be sure to celebrate any small wins you experience along the way.
Call New Directions Mental Health for Treatment Options for TRD
New Directions Mental Health provides compassionate, individualized care for clients facing depression in Pennsylvania. Whether it’s exploring innovative treatments like Spravato® or TMS, making adjustments to your current plan, or offering therapy tailored to your needs, our experienced team is here to help. Call us today at 724.374.7414 to schedule a consultation, or schedule your first appointment now.
Source:
- McIntyre, R. S., Alsuwaidan, M., Baune, B. T., et al. (2023). Treatment-resistant depression: definition, prevalence, detection, management, and investigational interventions. World psychiatry : official journal of the World Psychiatric Association (WPA), 22(3), 394–412. https://doi.org/10.1002/wps.21120
