Signs and Symptoms
While multiple treatment approaches are effective, no single treatment is universally effective for all patients. So, if you’re beginning treatment for your depression, the process may involve some trial and error. If you discover that various treatments are not working for you, you likely have treatment-resistant depression.
Treatment-Resistant Depression Symptoms
The primary symptoms of TRD include:
Depressive symptoms persist even after the treatment should have started workingSymptoms decrease somewhat with treatment, but not enough to substantially improve quality of lifeA treatment that used to work has lost effectiveness with ongoing treatmentFrequent relapses or recurrences of depression, even if treatment does result in a brief or partial remissionAn increase in dosage does not cause any change in your depressive symptomsThis lack of response occurs even though you are following the treatment plan as prescribed
Complications & Comorbidities
Little is known about why some patients respond to certain treatments but not others or why some don’t seem to respond to most available treatments. However, researchers have pinpointed some risk factors that make someone more likely to experience TRD. Those risk factors include:
Being assigned female at birthBeing over the age of 45Low socioeconomic statusLack of social support or family networksHaving a comorbid medical conditionHaving a comorbid psychiatric disorder
In addition, patients with certain forms of depression are more likely to be nonresponsive to one or more treatments.
Treatment-Resistant Depression and Misdiagnosis
TRD is largely defined by whether or not a patient responds to depression treatments. So it’s easy to overlook that, in some cases, they might not be responding simply because the diagnosis is wrong.
Psychotic symptoms like delusions or hallucinationsLonger lasting episodesMore frequent episodes
People Diagnosed With TRD May Have Been Misdiagnosed
If a patient with undetected asthma is not responding to allergy medication, diagnosing them with “treatment-resistant allergies” wouldn’t address the underlying source of their breathing problems. They did not receive the proper treatment. Emerging research suggests that many TRD patients might not respond to treatment because they either have an undetected comorbid condition or a different condition altogether that was wrongly diagnosed as major depressive disorder. One study found that 34% of participants with TRD met the diagnostic criteria for ADHD, for example. Another systematic review found that up to 50% of TRD patients met the criteria for bipolar spectrum disorder. ADHD and bipolar disorder are unlikely to respond to antidepressants, but these disorders do respond to other medications.
Chronic Depression vs. Acute Depression
A TRD diagnosis is based on viewing depression as an acute condition, meaning the treatments you try in that trial-and-error phase are meant to be used for a short period and lead to full remission, sort of like taking a short course of antibiotics to fully eliminate an infection.
Understanding Depression as a Chronic Illness
But some clinicians argue that TRD might be partially explained by the fact that some cases of depression are better understood as a chronic illness rather than an acute condition. Specifically, the DTD approach shifts the goal from full remission after acute treatment to optimal symptom control and overall improvement in quality of life. As a result, a long-term and holistic treatment approach is required. This type of treatment includes:
Addressing stressors in your environment or relationships that could trigger episodesRegularly re-screening for potential underlying comorbidities or health problems that might be causing or exacerbating your depressive symptomsUsing a mixture of acute treatments and long-term management techniques that can turn the illness into a more easily treated depression
Instead of plain trial and error, the approach emphasizes frequent review to ensure no diagnosis is missed and no potentially beneficial treatment is overlooked.
Can Treatment-Resistant Depression Be Treated?
Yes, treatment-resistant depression can be treated. TRD means you aren’t responding to first-line depression therapies like antidepressants. The growing body of research on the link between TRD and undiagnosed conditions like ADHD or bipolar spectrum disorder should also be considered an encouraging sign. When a patient can get a correct diagnosis and switch to a more appropriate treatment plan for that condition, it often improves the depressive symptoms in the process.
Is There Hope for Treatment-Resistant Depression?
After multiple trials of different treatments with no success, it’s easy to feel hopeless and “incurable.” But there is still a path forward, even if you haven’t had any luck with antidepressants. The biggest predictor of a positive outcome for patients with TRD was having social support. So if you have friends or family that you feel safe reaching out to, do that. If you don’t, consider joining a support group to surround yourself with people who understand what you’re going through.
Depression Resources
Here are some resources to help you find online and local depression support groups:
Mental Health America Anxiety and Depression Association of America Depression and Bipolar Support Alliance NAMI Connection
Ketamine Treatment
Outside of current treatment approaches, some emerging approaches have demonstrated especially hopeful signs of being able to treat TRD. Among those, ketamine may be the most promising. Several studies on TRD patients found that a ketamine infusion could significantly reduce depression, including suicidal ideation, in as little as three hours after treatment. The improvements lasted an average of 5 to 7 days.
