When Depression Won't Go Away
Treatment Resistant Depression (TRD): What is it and what can be done?
Many people with depression respond very well and quickly to treatment. But some people do not respond to the usual course of treatment (talk therapy and/or antidepressants) and need more help. If two to three drug treatments fail, a person may be considered treatment resistant. However, new treatments, especially in the past year, are providing new options and paths out of depression even for those whose illness is considered treatment resistant. We hope this information will help you make informed decisions - choices that can lead to recovery. Every day, we learn more about depression. Every day brings more hope and a brighter future.
It is best to discuss these issues and options with a psychiatrist that specializes in treatment-resistant depression. You may need more than one psychiatrist's opinion. These psychiatrists often work at psychiatric hospitals or large hospitals.
1. Diagnosis and Medication Issues
| Treatment Issue |
Ask yourself |
What to consider |
More information |
| Proper diagnosis |
Are you suffering from bipolar disorder or major depression? |
Proper diagnosis by a psychiatrist who treats patients with bipolar disorder. Possible second opinion. Two thirds of those with bipolar disorder are misdiagnosed, often with depression. Those suffering from bipolar disorder, which brings rapid swings between "highs" and "lows" in mood, can be mistakenly diagnosed as having major depression during their "down" cycles. The two illnesses require different treatments and medications. Bipolar Disorder requires mood stabilizers - which are different medications than the antidepressants used to combat depression. |
Learn about Bipolar Disorder
Look at your family history for possible bipolar disorder |
| Adequate medication/treatment time |
Have you received adequate medication for enough time? |
Star*D Study - Most comprehensive U.S. study of treatment alternatives. Conclusion: Even when initial treatment fails, as many as two-thirds of patients recover adding or switching medications. |
Find out about the Star*D Study:
Questions and Answers about the NIMH Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study
Different Drug Often Works in Depression, Study Finds |
| Have you exhausted all choices for medications and therapy? |
Have you tried talk therapy? Have you tried only newer antidepressants such as SSRIs and SNRIs? |
A combination of medication and talk therapy is effective in treating depression. Other classes of antidepressants, including MAO inhibitors and tricyclics may help. The MAO inhibitor patch is new alternative, approved by the FDA recently. |
Learn about MAO Inhibitors and Tricyclics:
New Medical Products |
| Do you have any other illnesses that contribute to your depression? |
Do you have any other medical illnesses such as a thyroid condition, anemia, cardiac abnormalities, anxiety disorder, or alcohol or drug problems that need to be addressed? |
Make sure your doctor does a comprehensive examination for other conditions. Let your doctor know about aconditions you are aware of. Also tell your doctor if you are drinking alcohol or taking drugs. |
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2. Alternative Treatments to Medications (and Talk Therapy)
| Treatment |
Procedure/Considerations |
| Electroconvulsive (ECT) therapy. |
FDA Approved.
Patient is anaesthetized; an electrical current is then passed through the brain, inducing a seizure
High success rate and according to the National Institute for Mental Health, "much improved" in recent years.
Concerns: Risks associated with seizure, memory loss, and general anesthesia. |
Vagus Nerve Stimulator
(VNS Therapy) |
FDA Approved.
Pacemaker-like device is implanted in chest to stimulate the areas of the brain regulating moods. |
Repetitive Transcranial Magnetic Stimulation (rTMS)
(TMS Therapy) |
FDA Approved.
Pulses of magnetic energy stimulate nerve cells in the brain. This is now FDA approved. See Neuronetics website. |
This focus on treatment-resistant depression is made possible by: Cyberonics, SLS Health, Neuronetics, McLean Hospital, WestBridge Community Services, Austen Riggs Center
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