When depression doesn't improve despite treatment, it can be incredibly frustrating and exhausting. You may start to wonder why you're not getting better, whether you've done something wrong, or whether things will ever change. Treatment-resistant depression doesn't mean there is no hope. It means it may be time to look more closely at your symptoms, your treatment and what other options may be available.
Depression doesn't look the same for everyone, and neither does recovery.
For some people, symptoms improve with their first treatment. For others, finding an approach that works can take time.
You might have tried medication, psychological therapy, lifestyle changes or a combination of treatments, but still feel that you're struggling with:
When symptoms continue despite appropriate treatment, your doctor or psychiatrist may consider whether you are experiencing treatment-resistant depression (TRD).
Treatment-resistant depression generally refers to depression that hasn't improved sufficiently after trying appropriate treatments.
There isn't a single definition that applies to every person. Your psychiatrist will consider factors such as the treatments you've tried, the dose and duration of medication, how consistently treatments were followed, your symptoms and other factors that may be contributing to your depression.
Importantly, treatment-resistant doesn't mean untreatable.
It means that the usual treatment approaches haven't provided the improvement you're hoping for, and it may be worth considering a different approach.
There can be many reasons someone doesn't respond to a particular treatment.
Depression can sometimes occur alongside other mental health conditions, physical health conditions or significant life stressors. Sleep problems, substance use, medication side effects and other factors can also affect how someone feels.
Sometimes the diagnosis or treatment approach needs to be reconsidered.
Your psychiatrist may therefore take a closer look at:
This isn't about blaming you or suggesting you haven't tried hard enough. Depression is a medical condition, and sometimes treatment needs to be adjusted before the right approach is found.
If your depression isn't improving, your psychiatrist may discuss changing or combining treatments.
Depending on your individual circumstances, this could include:
Sometimes a medication may need to be adjusted, changed or combined with another treatment. Your psychiatrist can review what you've previously tried and consider what may be appropriate next.
Psychological therapies can play an important role in treating depression. Different approaches may be helpful for different people, depending on their symptoms, circumstances and treatment goals.
Treatment isn't only about medication.
Your psychiatrist may also look at sleep, physical health, relationships, stress, substance use, daily routines and other factors that could be affecting your recovery.
For some people with persistent or treatment-resistant depression, additional treatment options may be considered, including treatments such as transcranial magnetic stimulation (TMS) or esketamine.
These treatments aren't appropriate for everyone, and suitability needs to be assessed by a qualified medical professional.
Transcranial magnetic stimulation (TMS) is a non-invasive treatment that uses magnetic pulses to stimulate specific areas of the brain involved in mood regulation.
TMS is delivered while you are awake and does not require a general anaesthetic.
A course of treatment usually involves repeated sessions over a period of time, with the exact treatment schedule determined by your treating team.
For some people with treatment-resistant depression, TMS may be considered when standard treatments haven't provided sufficient improvement.
Esketamine is a medication that works differently from traditional antidepressants and may be considered for some people with treatment-resistant depression.
It is administered under medical supervision, with patients monitored during treatment.
As with any treatment, esketamine has potential benefits, risks and side effects. Your psychiatrist will assess whether it is appropriate for you based on your individual circumstances.
One of the hardest parts of ongoing depression can be feeling like you've tried everything.
You may have reached a point where you're thinking:
“What's the point of trying another treatment if nothing has worked so far?”
It's understandable to feel this way.
But a lack of improvement with one treatment doesn't necessarily tell us how you'll respond to another. Sometimes treatment involves finding the right combination of approaches, adjusting the treatment plan or considering options that work in a different way.
Your treatment journey may not look like someone else's.
If you've been experiencing depression and don't feel that your current treatment is helping, speak with your GP or psychiatrist.
You don't need to wait until your symptoms become severe before raising your concerns.
You can tell your treating professional:
“I'm not feeling better and I'm not sure what to try next.”
That conversation can be the starting point for reviewing what's happening and exploring whether there are other treatment options to consider.
Living with depression that hasn't responded to treatment can be incredibly difficult. It can affect your relationships, work, motivation and sense of hope.
But treatment-resistant depression does not mean you have run out of options.
If your current treatment isn't working, it may be time for a review and a conversation about what comes next.
At Nundah Private Hospital, our psychiatrists can assess people experiencing persistent or treatment-resistant depression and, where clinically appropriate, consider treatment options including TMS and esketamine.
The next step doesn't have to be figuring everything out yourself.
Sometimes it's simply starting a conversation about what hasn't worked - and what else might be worth considering.
