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What Is Treatment-Resistant Depression?

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Treatment-resistant depression is major depressive disorder that doesn’t improve after at least two antidepressant medication trials, where each trial used an adequate dose for an adequate length of time. While it presents challenges, options are available. This article explains the condition and how BlueCrest Health Group provides support.

Key Takeaways

  • Treatment-resistant depression is a major depressive disorder that does not respond to at least two rounds of antidepressant medications when taken as prescribed.
  • TRD can be caused by a misdiagnosis, co-occurring disorders, treatment-related factors, or biological and lifestyle factors.
  • It is diagnosed through an evaluation that considers treatment history, medical history, substance use, and co-occurring conditions.
  • Treatment typically includes medication adjustments, therapy, specialized treatments, or transfer to a higher level of care. Lifestyle interventions can also help.

Table of Contents

Introduction

Depression is one of the most common mental disorders in the United States, with about 18.5% of U.S. adults having been diagnosed with the condition at some point in their lives, but effective treatment is available. Therapies and medication relieve depression symptoms, making people feel more like themselves again. But for some, the first treatments they try don’t bring the relief they hoped for. They may try different depression medications, but feelings of sadness and hopelessness linger.

What is treatment resistant depression- therapy can help

If you find yourself in this cycle, you may be experiencing treatment-resistant depression (TRD). While the name sounds discouraging, hope remains. Therapists often explore why certain approaches aren’t working and try different methods until the client finds relief.

This article explains what treatment-resistant depression is, why it happens, and what options are available.

What Is Treatment-Resistant Depression?

Treatment-resistant depression is defined as major depressive disorder that doesn’t respond to at least two antidepressant medication trials when used at an adequate dosage for the recommended length of time. Research published in the National Library of Medicine reveals that about 8.9 million U.S. adults receive medication treatment for major depressive disorder in a given year, and roughly 2.8 million of them (30.9%) have treatment-resistant depression (TRD).

When determining whether treatment is working, mental health professionals look at three possible outcomes:

  • Response: Symptoms improve significantly, typically by 50% or more
  • Remission: Symptoms improve so much that they’re minimal or gone
  • Partial response: Some improvement, but meaningful symptoms remain

Many people with TRD fall into the partial response category, while remission is the goal.

What Are the Signs of Treatment-Resistant Depression?

Telltale signs of treatment-resistant depression are tied to the lack of medication effectiveness, as follows:

  • Your depression symptoms haven’t improved after trying two or more antidepressants
  • You feel somewhat better but still struggle with low mood, fatigue, or lack of interest in things
  • Your symptoms improved at first and then returned
  • Side effects made it hard to stay on medications long enough to know if they worked
  • You’ve been cycling through medications without significant relief

What Causes Treatment-Resistant Depression?

TRD is typically tied to misdiagnosis, co-occurring conditions, inadequate doses and treatment periods, and biological and life factors.

  • Misdiagnosis: Your depression may not be responding to treatment because it was misdiagnosed. For example, bipolar disorder is often misdiagnosed as major depression, which is why treatments may not be working.
  • Co-Occurring Disorders: The depression may be responding to treatment, but a co-occurring condition is still driving symptoms. This is common when depression occurs alongside anxiety, substance use, trauma, PTSD, chronic pain, and illness.
  • Treatment-Related Factors: A reduced response may occur if doses are too low, the trial period is too short, doses are missed, or side effects make it difficult to continue treatment.
  • Biological and Life Factors: Everyone has different genetics that impact how they process medications, which is why one medication can work well for one person and not another. Various life factors can also impact effectiveness. For example, a traumatic life event, grief, and loss can make it difficult to feel happy.

How Is Treatment-Resistant Depression Diagnosed?

The mental health condition is typically diagnosed based on treatment history, a diagnostic re-evaluation, substance use screenings, and medical assessments.

  • Treatment History: The provider will review your treatment history, including the medications you’ve taken and how you’ve responded.
  • Diagnostic Evaluation: This will help providers determine if you are dealing with MDD or another mental health condition and whether co-occurring conditions exist.
  • Substance Use Screening: Determines whether substance use is responsible for lingering symptoms.
  • Medical Assessments: Help doctors determine whether physical health conditions contribute to the lack of response.

What Are Treatment Options for TRD?

Treatment options for TRD include medical adjustments, evidence-based therapies, high-intensity care, specialized treatment, and lifestyle interventions.

Medication Adjustments

Your doctor may adjust the dose, change medications, or add a new medication.

Evidence-Based Therapy

Therapy is one of the most effective yet often overlooked tools for treatment-resistant depression, enhancing the effects of medication as a complementary methodology. A CoBalT trial, published in The Lancet, reveals that 46% of people whose depression hadn’t responded to antidepressants and received CBT in addition to usual care for six months had improved, reporting at least a 50% reduction in depression symptoms, compared to 22% of those who continued with usual care alone.

Therapies that can help TRD include:

  • Cognitive Behavioral Therapy (CBT): Addresses negative thought patterns and teaches clients coping strategies to guide healthier responses.
  • Dialectical Behavioral Therapy (DBT): An offshoot of CBT, this offers a more mindful approach to emotional regulation with a focus on distress tolerance.
  • Trauma-Focused Therapy: Implemented when trauma is driving depressive symptoms.

Structured, Higher Intensity Care

Sometimes clients may not see results because they need higher-intensity care. For example, someone in a traditional outpatient program may need to step up to intensive outpatient or partial hospitalization care. These higher levels provide a more structured approach, more medical oversight, and more clinical hours.

Specialized Treatments

If TRD does not respond to traditional treatments, providers may implement specialized services. These include:

  • Esketamine (Spravato): A nasal spray approved by the FDA in 2019 for adults with treatment-resistant depression. It’s given in a certified medical setting under supervision.
  • Ketamine: Some providers offer ketamine infusions for depression, though this use is considered off-label.
  • Transcranial magnetic stimulation (TMS): A noninvasive treatment that uses magnetic pulses to stimulate areas of the brain involved in mood regulation.
  • Electroconvulsive therapy (ECT): A procedure done under general anesthesia that is used for severe depression that hasn’t responded to other treatments.
  • Vagus nerve stimulation (VNS): An implanted device that sends mild electrical signals to the brain. It’s typically considered for long-term, severe depression.

Specialized providers typically offer these treatments, and your care team can help coordinate a referral if needed.

Lifestyle Changes

While these can’t replace clinical treatments, they can enhance the effects. Regular exercise, a steady sleep routine, and a nutritious diet can improve depression symptoms alongside therapy and medications.

What Are Tips for Living with TRD?

therapy for treatment resistant depression

It can be frustrating to deal with treatment that isn’t working, but staying persistent gives you and your care team the best chance of finding what works. Here are some tips to keep in mind to ease depression symptoms and help you achieve the best possible results.

  • Stay engaged with treatment, even when progress feels slow
  • Track your symptoms so you and your providers can see what’s changing
  • Be honest with your treatment team about side effects, missed doses, alcohol or drug use, and how you’re really feeling
  • Lean on your support system, whether that’s family, friends, or a support group

Get the Help You Need Through BlueCrest Health Group

BlueCrest Health Group understands the complexities of dealing with mental health conditions and offers a comprehensive approach. We provide a wide range of therapies across various levels of outpatient care. Clients can enroll in our recovery or counseling tracks to benefit from a whole-person approach that supports optimal wellbeing.

Contact us to learn more about our extensive programs.

FAQs

What is treatment-resistant depression?

Treatment-resistant depression is depression that doesn’t improve after at least two antidepressant medications, each taken at an adequate dose for an adequate length of time. It’s a recognized condition, and it doesn’t mean depression can’t be treated.

How do I know if I have treatment-resistant depression?

You may have TRD if you’ve tried two or more antidepressants and still have significant symptoms, or if your symptoms improved only partially or came back. A mental health professional can review your treatment history and determine what’s going on.

How common is treatment-resistant depression?

TRD is more common than many people realize. Estimates suggest that roughly one in three adults taking medication for depression has treatment-resistant depression.

What causes treatment-resistant depression?

TRD often has multiple causes. Common factors include a missed diagnosis such as bipolar disorder, co-occurring conditions like anxiety, trauma, or substance use, medication doses or trials that weren’t adequate, and genetic differences in how the body processes medication.

Can treatment-resistant depression be cured?

Many people with TRD do reach remission, meaning their symptoms become minimal or go away. It may take a different or more comprehensive approach, but recovery is possible.

Sources

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