Most people are familiar with standard depression symptoms, loss of motivation, fatigue, negative thought patterns, loss of interest, isolation, etc. but have you ever heard of the term treatment-resistant depression?

The term treatment-resistant depression has been used more readily over the past few years and is appearing more often in the medical records of many individuals who have struggled with depression for many years. Today we will take some time to explore what is treatment-resistant depression, and what those who receive this diagnosis of treatment-resistant depression may be able to do in order to work towards better health and wellness and management of the symptoms.

So what is treatment-resistant depression?

Treatment-resistant depression is a term that refers to depression that does not respond to normal medication and psychotherapy treatments (1); however, the relative newness of this term has left some discrepancy in the exact qualifications for meeting this criterion. For research criteria, many researchers are defining treatment-resistant depression as depression that does not respond to “traditional first-line therapeutic options.” (2)

So what do we know about treatment-resistant depression?

Despite the many unknowns, there are a few things to keep in mind (3):

Up to one-third of those with major depressive disorder have symptoms that do not respond to first line medication treatment
Women and senior citizens tend to experience treatment-resistant depression at increased rates.
The exact cause of depression is still largely unknown so there continues to be large uncertainty related to what factors contribute to those who do respond to first-line medication and those that don’t.

The term treatment-resistant depression feels a little hopeless. Are there treatment options for treatment-resistant depression?

We are so glad you asked! Yes, that term tends to have a pretty negative or grim feeling vibe to it, but there truly are options for those who are experiencing or battling treatment resistant depression. The Mayo Clinic outline several steps or considerations for those that are struggling with treatment-resistant depression symptoms (4).

If you are experiencing treatment-resistant depression, here are a few things that you can consider or options that you may consider exploring with your team of mental health providers and doctors:

Consult with additional physicians for alternative perspectives of medication management.

Many of my clients, as they are starting their mental health journey, will receive support from their primary care physicians related to anxiety and depression medications. If the first-line medications for depression management are not appearing to be effective for you, this may be a time to reach out for a referral to a psychiatrist, or a doctor specializing in the medication management of mental health-related disorders.

It may also be helpful to research or learn which doctors in the area tend to specialize in treatment-resistant depression. Every doctor has their own niche that they develop specific expertise, so finding a provider that may specialize in some of the symptoms or concerns that you’re struggling with may be a great option to explore. (To be very clear, advice on medication is outside of the scope of practice of mental health therapists, however, the trend that we have observed in treatment is that some primary care physicians do feel comfortable prescribing first-line depression medications prior to referring out to a psychiatrist, and others will refer to a psychiatrist at the first sign of depression.)

Consider alternative types of therapy.

The great thing about depression is, it is so common that there are plenty of interventions and evidence-based practices to assist in lessening the symptoms of depression. If you are currently not having success with your current line of treatment for depression symptoms, talk with your therapist about alternative treatment options. For example, your therapist may be utilizing a cognitive behavioral approach, and it is possible that another approach like DBT therapy, EMDR therapy, acceptance commitment therapy, or others may be more in line with your needs and more effective in treating your specific symptoms.

Consider all behavioral changes that you can control.

While depression certainly is an internal process for many people, most individuals who struggle with depression can identify that their depression symptoms do connect with factors existing in their outside worlds. Sometimes it can be helpful to consider where the majority of depression symptoms are connected within our environment, and consider boundary setting, changing environments, and other changes that may be able to be implemented to reduce the triggers for depressive symptoms.

Similarly, things like healthy eating, sleep routines, exercise, and other healthy habits are equally as important in depression resistant to treatment as it is in more typically presenting forms of depression symptoms.

There are some additional treatment options.

While these approaches may not be for everyone and must be fully evaluated and prescribed by a practicing physician, there is some research related to the effectiveness of some alternative forms of depression treatment. These include:

Repetitive transcranial magnetic stimulation (rTMS)
Ketamine
Electroconvulsive therapy (ECT)
Vagus nerve stimulation (VNS

Anyone interested in learning more about these specific types of intervention should consult with their medical team related to the appropriateness of these interventions, the risks, and the potential benefits involved.

If you are interested in further exploring possible interventions for therapy for your depression symptoms, our team is ready to help. We employ highly trained therapists with expertise and a variety of models to assist in varied approaches to meeting the mental health needs of our clients. EMDR therapy, DBT therapy, and other cognitive-based therapies are available both through our online therapy services as well as in person at our Arlington, Texas-based therapy office. Let a member of our team join you in your journey toward better depression management!

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