Standard treatments help many people with depression, but not everyone. Approximately 30% of individuals who try multiple antidepressants continue to have severe symptoms called treatment-resistant depression. If this happens, it’s important to know that there are still ways to manage your depression. It’s important to discuss all treatment options with your doctor and not give up.
Experts don’t have a single definition for treatment-resistant depression, but it’s generally when a person’s depression doesn’t improve after trying two different antidepressants from different drug classes. Before receiving a diagnosis, it’s recommended to go through at least two rounds of antidepressant treatments, giving each medication about 6 to 8 weeks to work. Your doctor might also raise the dosage of the current medication before switching to another medicine.
There are various reasons why individuals might not respond to antidepressants, including not taking their medication daily, the body not absorbing the drug properly, having other health conditions like an underactive thyroid, or experiencing stress and additional turmoil in their lives. While there are theories about genetic and brain differences, there isn’t a definitive answer about what causes treatment-resistant depression. Precision medicine is an approach that might help personalize treatment for certain groups, such as individuals with treatment-resistant depression and inflammation.
Symptoms of treatment-resistant depression aren’t significantly different from other forms of depression, but if someone has no joy, pleasure, or excitement in their life, it’s a good time to speak with a therapist or doctor. Managing treatment-resistant depression might involve more than just medication, including adjunctive medication, talk therapy, ketamine, and brain stimulation such as repetitive transcranial magnetic stimulation (rTMS), electroconvulsive therapy (ECT), or vagus nerve stimulation (VNS). The goal of treatment should be to work towards getting better rather than accepting a partial improvement. This might include a combination of treatments with the help of a knowledgeable psychiatrist.