About one-third of adults with major depressive disorder struggle with symptoms such as persistent sadness, disturbed sleep, low energy, and thoughts of death or suicide, that don’t respond to treatment [1].
It can be challenging for you and your doctor to find the right anti-depressant medication. It takes time for each medication to take effect (4-12 weeks depending on the specific medication) only to find that it’s not working. Doctors may recommend alternatives but each again takes time to verify effectiveness.
For some, none work. This is known as treatment-resistant depression or TRD. Nonetheless there are a variety of avenues which can be pursued for alternative treatments. Read on to learn more about these choices.
Strategies Doctors May Use
There are five main treatment strategies doctors may use to create personalized treatment plans to manage treatment-resistant depression [1] [2]:
- Optimization: Increase the dose of current medication.
- Switching: Select another medicine to replace the current one.
- Combination: Use two or more antidepressant medications simultaneously.
- Augmentation: Use a non-antidepressant medication such as an antipsychotic to supplement the antidepressant medication.
- Somatic Therapies: Use Transcranial Magnetic Stimulation (TMS), Electroconvulsive Therapy (ECT), or Vagus Nerve therapies, explained below.
Consult a Specialist
The first step is to seek a second opinion from a psychiatrist or psychiatric nurse practitioner specializing in depression. Consider getting a comprehensive evaluation, which may include talking with family members to gather information on family history of depression.
Medication Adjustments
Follow these steps in this process [3] [4]:
- Review medication adherence with your doctor to ensure you’re taking it as prescribed.
- Allow sufficient time (4-12 weeks) for the medication to reach therapeutic levels
- Discuss with your doctor about:
- Increasing the dosage.
- Adding another medication (adjunct therapy).
- Switching to another antidepressant.
- Trying combination therapy with antidepressants from different classes of medication.
- Augmentation therapy with non-antidepressant medications like antipsychotics or anticonvulsants.
Consider Psychotherapy Options
There are a number of evidence-based therapies for treatment-resistant depression, including:
Cognitive Behavior Therapy (CBT)
This is a short-term, evidence-based psychotherapy that targets negative thought patterns and behaviors. By changing dysfunctional thinking, CBT helps improve emotions and actions. Effective for depression, it uses cognitive restructuring and behavioral activation to build healthier coping skills and promote emotional well-being.
Acceptance and Commitment Therapy (ACT)
This is a mindfulness-based psychotherapy that encourages individuals to accept their thoughts and feelings rather than fighting or feeling guilty for them. It focuses on committing to actions that align with personal values, enhancing psychological flexibility, and improving overall mental health and well-being.
Interpersonal Therapy
This is a time-limited, evidence-based approach that focuses on improving interpersonal relationships and communication. It addresses issues like unresolved grief, role transitions, conflicts, and social isolation. It aims to alleviate symptoms of mental health disorders, particularly depression, by enhancing relational skills and fostering healthier connections with others.
Dialectical Behavior Therapy
This is a cognitive-behavioral approach designed to help individuals manage emotions, reduce self-destructive behaviors, and improve relationships. It combines acceptance and change strategies, teaching skills in mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. It is particularly effective for borderline personality disorder and other emotion regulation challenges.
Consider Non-medication Treatments
In recent years evidence has proven that several non-medication treatments can be effective for treatment-resistant depression, including [3] [4]:
Transcranial Magnetic Stimulation (TMS)
TMS is a non-invasive procedure using magnetic fields to stimulate nerve cells in the brain, primarily used to treat depression and other mental health disorders. It targets specific brain regions, offering an alternative for patients unresponsive to medication, with minimal side effects and no need for anesthesia.
Electroconvulsive Therapy (ECT)
This is a psychiatric treatment involving brief electrical stimulation of the brain to induce controlled seizures, primarily used for severe depression, bipolar disorder, and schizophrenia. Performed under anesthesia, it is effective for treatment-resistant cases, but may cause memory-related side effects. ECT is considered safe and is regulated.
Vagus Nerve Stimulation (VNS)
This treatment involves a device implanted under the skin to send electrical impulses to the vagus nerve, which connects to the brain. Used for epilepsy and treatment-resistant depression, it modulates brain activity, reducing symptoms over time. It is a long-term therapy with generally mild side effects.
Innovative Ketamine-AssistedTherapy
This innovative approach combines low doses of ketamine, a dissociative anesthetic, with psychotherapy to treat mental health conditions like treatment-resistant depression, PTSD, and anxiety. Leveraging ketamine’s rapid-acting antidepressant effects (within hours) to enhance emotional openness and neuroplasticity, it creates a window for deeper psychotherapeutic work.
Administered in controlled settings, it helps patients process trauma, reframe thoughts, and achieve longer-term emotional healing, although repeated administration after several months to a year may be necessary. This innovative approach shows promise for treatment-resistant cases, where at least two prior traditional methods have been unsuccessful.
Lifestyle and Self-Care
Among the many ways you can practice self-care, these are essential for healing from depression:
- Stop drinking or using recreational drugs.
- Maintain a healthy lifestyle with a balanced diet and regular exercise.
- Practice stress-reduction techniques like mindfulness or meditation.
- Ensure you practice good sleep hygiene, with adequate regular sleep.
Treatment-resistant depression continues to challenge mental health care providers, and further relevant research involving newer drugs is underway to improve the quality of life of patients with the disorder.
Remember, finding the right treatment may take time and patience. It’s important to communicate openly with your healthcare provider about your symptoms and any side effects you experience. With persistence and the right approach, it’s possible to find an effective treatment plan for depression, even when initial medications don’t work as expected.
Therapy for Depression in Utah
Harper Clinic understands the difficulty in treating treatment-resistant depression and offers somatic therapies such as TMS and Ketamine Therapy to process emotional distress, reduce symptoms, and improve one’s overall health.
Get in touch with us through text, phone call, or our direct Vagaro booking. We will verify insurance, schedule your first consultation, and design a treatment plan tailored to your specific health needs.
Sources
[1] Brown J. 2018. 4 things we now know about treatment-resistant depression. Johnson & Johnson.
[2] Al-Harbi KS. Treatment-resistant depression: therapeutic trends, challenges, and future directions. Patient Prefer Adherence. 2012;6:369-88
[3] Treatment-resistant depression. MayoClinic.org
[4] Treatment-Resistant Depression. WebMD.com
