Treatment-Resistant Depression

Depression is a serious health condition that affects more than 15 million American adults and is on its way to becoming the second most common health problem in the world by the year 2020. Although depression can be treated, about 10 to 30 percent of people experience what is called treatment-resistant depression.

A person is diagnosed with treatment-resistant depression if the person has had no relief from depression symptoms despite numerous treatments – for established periods of time – at the correct dose and frequency.  There are many options for treatment-resistant depression:

  • Optimization. Often time, individuals with depression are not getting the results they want because the drug they are prescribed is not taken at a high enough dose or for a long enough period of time. Your dose of antidepressant may need adjusting to get better results. Some antidepressants work better at higher doses. Others have a window of dosing in which they may work the best for you while having the fewest side-effects.
  • Substitution. If an antidepressant still does not work after a high enough dose has been taken for a long enough period of time, switching to a different class of antidepressant medication may help. Studies have shown that 30 to 50 percent of people with treatment-resistant depression responded well after switching the type of antidepressant they were taking to one that works in a different manner. There are about 30 antidepressants belonging to about 8 classes available in the US. Even among patients who have had trials of multiple medicines, most have tried only 2-3 classes.
  • Combination. If taking one antidepressant is ineffective, some depressed individuals respond well to adding another type of antidepressant to their dosage.  If you have partial response to a given medicine, adding another medicine that is compatible with the first medicine may allow you to build on the effectiveness of the above medicine. While this can often be effective, the possibility of increased side effects must be noted.
  • Psychotherapy.  Sometimes taking an antidepressant by itself is not enough for it to work, however, adding psychotherapy with a mental health professional can often help. Therapy can offer you new ways to manage stress and avoid negative events that can set off depressive symptoms.
  • Support Groups. Talking with other individuals who also suffer from depression may help one feel less alone and more informed about depression and its treatments.
  • Neurostimulation. Treatment resistant depression can also be treated with neurostimulation, which is a type of therapy in which electrical impulses are used to treat depression. Electroconvulsive therapy (ECT) is the most effective treatment for clinical depression that does not respond to other treatment. Vagal nerve stimulation (where electrodes are placed on the chest), is another type of neurostimulation that has been approved for treatment-resistant depression.
  • TMS (Transcranial Magnetic Stimulation). TMS is a treatment that involves repeatedly delivering very short magnetic pulses to the part of the brain that is believed to be involved in depression. It has few side-effects, but carries a small risk of seizures.