Accepting that you have depression and submitting yourself to treatment is difficult enough as it is, but what happens when months pass and you still feel no relief? You’re going to therapy almost religiously and taking your medication, yet you don’t feel as if the darkness that’s constantly looming has lifted? If this is the case, then you most likely have what is called treatment-resistant depression (TRD) or refractory depression.
There’s no easy fix for depression and, unfortunately, almost a third of people suffering from this mental health disorder ultimately don’t respond to any attempts at treatment. Two-thirds of depressed individuals don’t find the first antidepressants they try to be of any help at all.
Treatment-resistant depression can be incredibly demoralizing, as months and years can pass without you feeling and seeing any results of getting better. It can leave depression patients discouraged and hopeless, and make matters even worse. However, if this does happen, it’s important to notice that your medication and/or therapy is not helping you, and tell your doctor as much.
Although it may seem like a mission impossible, TRD can be successfully managed—it just takes a bit more effort from you and your doctor’s side. This effort may include finding a different approach to your disorder and trying out other drugs, therapy, and alternative treatments. What follows are the steps you’ll need to take if you believe that you have TRD.
Step One: Confirm the Diagnosis with Your Doctor
TRD can be extremely hard to diagnose and it’s frequently misdiagnosed because other conditions can cause similar symptoms. Bipolar disorder, problems with alcohol or drugs, and certain medical conditions, such as hypothyroidism, can all cause symptoms of depression and lead to incorrect treatment. In some cases, depression will go hand-in-hand with other medical or psychiatric disorders (anxiety, eating, or personality disorders), making it more difficult to treat, especially if the additional disorders are left untreated.
And while a primary care doctor can treat depression, in the case of TDR it might be better to turn to a specialist, such as a psychiatrist or a psychologist. They will be able to confirm the diagnosis and then proceed to change your therapy accordingly.
Step Two: Check If You’re Using Your Medicine the Right Way
A large number of patients with depression (almost half of the people who get prescribed drugs for depression) end up taking their medicine the wrong way. They either miss their doses entirely or stop taking the drugs due to various side effects. Some even stop taking them because they don’t enough patience to wait for the drugs to kick in—antidepressants sometimes need 4-12 weeks to start working.
Step Three: Look for Other Causes
As already mentioned, other issues, ranging from substance abuse to thyroid problems, can make depression worse or be the cause of it. Certain drugs used to treat common medical issues can be the reason why your prescribed treatment isn’t working and why you’re not getting any better. In some cases, patients need to switch medication or treat the other condition ailing them first, in order to be able to rid themselves of TRD.
What you need to remember is that not all forms of depressions are the same, and not everyone will react in the same manner to certain drugs. Some people will begin to feel better sooner than others, while there are those who simply won’t feel better at all. According to research, patients with severe or long-term depression are harder to treat.
Step Four: Switch or Add New Medicine
If the drugs you’re currently using aren’t helping you, then you might need to change your medicine or add a new one to your therapy. Once you’re diagnosed with TRD, your doctor might switch your antidepressants and prescribe your new ones from a different class. So, for example, if you were taking an SSRI (Zoloft, Prozac, etc), you might get an SNRI (Fetzima, Cymblata, and so on). Different antidepressants affect different chemicals in our brains, so sometimes switching from one class to another can make a huge difference for you.
In some cases, your doctor will prescribe adjunct therapy or augmentation therapy, i.e. add a new medicine to the one you’re already using. If your current drug is helping relieve your symptoms at least a little bit, then this is a good solution. Adjunct therapy includes adding medicine from another class, whereas augmentation means using a drug that’s typically not used in treating depression.
Learning to Live with Treatment-resistant Depression
It sounds easier said than done, especially when one treatment after another doesn’t help. When you find yourself at your lowest, everything that you’ve done and is still doing (different therapy and sessions) might start to seem like a waste of time. But know this: getting to the right treatment for depression can take some time, especially with TRD. Look at it this way: with every new option, you’re getting closer to finding the one that actually works.
So, no matter what, don’t give up and simply accept your depression. There is a number of good treatments for depression out there, and you just need to stumble upon the right one for you. Dr. Best and his team at the Neuroscience Center have successfully treated patients with TRD for years, so don’t hesitate to contact us for more details and allow us to help you.
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