How to Manage Treatment-Resistant Depression

What is treatment-resistant depression?


Feeling sad or hopeless from time to time is a normal and natural part of life. It happens to everyone. For people with depression, these feelings can become intense and long-lasting. This can lead to problems at work, home, or school.


Depression is usually treated with a combination of antidepressant medication and certain types of therapy, including psychotherapy. For some, antidepressants provide enough relief on their own.


While antidepressants work well for many people, they don’t improve symptoms for 10–15 percentTrusted Source of people with depression. In addition, 30–40 percentTrusted Source notice only a partial improvement in their symptoms.


Depression that doesn’t respond to antidepressants is known as treatment-resistant depression. Some also refer to it as treatment-refractory depression.


Read on to learn more about treatment-resistant depression, including treatment approaches that can help.

How is treatment-resistant depression diagnosed?

There’s no standard diagnostic criteria for treatment-resistant depression, but doctors generally make this diagnosis if someone has tried at least two different types of antidepressant medication without any improvement.


If you think you have treatment-resistant depression, it’s important to get a diagnosis from a doctor. While you might have treatment-resistant depression, they’ll want to double-check a few things first, such as:


Was your depression correctly diagnosed in the first place?

Are there other conditions that could be causing or worsening symptoms?

Was the antidepressant used in the right dose?

Was the antidepressant taken correctly?

Was the antidepressant tried for a long enough time?

Antidepressants don’t work quickly. They usually need to be taken for six to eight weeks in appropriate doses to see the full effect. It’s important that the medications are tried for a long enough time before deciding that they aren’t working.


However, some research shows that people who show some improvement within a couple weeks of starting an antidepressant are more likely to eventually have a full improvement in their symptoms.


Those who don’t have any response early in treatment are less likely to have full improvement, even after several weeks.


What causes treatment-resistant depression?

Experts aren’t sure why some people don’t respond to antidepressants, but there are several theories.


Some of the most popular ones include:


Incorrect diagnosis

One of the most common theories is that people who don’t respond to treatment don’t actually have major depressive disorder. They may have symptoms similar to those of depression, but actually have bipolar disorder or other conditions with similar symptoms.


Genetic factors

One or more genetic factors likely have a role in treatment-resistant depression.

Certain genetic variations may increase how the body breaks down antidepressants, which could make them less effective. Other genetic variants might change how the body responds to antidepressants.


While a lot more research is needed in this area, doctors can now order a genetic test that may help to determine which antidepressants will work best for you.


Metabolic disorder

Another theory is that people who don’t respond to treatment may process certain nutrients differently. One study found that some people who don’t respond to antidepressant treatment have low levels of folate in the fluid around the brain and spinal cord (cerebrospinal fluid).


Still, no one’s sure what causes this low level of folate or how it’s related to treatment-resistant depression.


Other risk factors

Researchers have also identified certain factors that increase your risk of having treatment-resistant depression.


These risk factors include:


Length of depression. People who’ve had major depression for a longer period of time are more likely to have treatment-resistant depression.

Severity of symptoms. People with very severe depression symptoms or very mild symptoms are less likely to respond well to antidepressants.

Other conditions. People who have other conditions, such as anxiety, along with depression are more likely to have depression that doesn’t respond to antidepressants.


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