5 Signs Your Depression is Treatment-Resistant

Living with depression is a challenging journey. For some, finding effective treatment can feel like an uphill battle. Have you been feeling persistently depressed? If you have tried various therapies without success, you may have treatment-resistant depression (TRD).¹

TRD is quite common. About 30 percent of people with depression have TRD.^2,3

What is treatment-resistant depression?

With resistant depression, at least 2 different first-line antidepressants have not worked to treat your symptoms. First-line antidepressants include SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin and norepinephrine reuptake inhibitors).^2,4

To get a diagnosis, you must have taken 2 different antidepressants. You must have taken them for at least 6 to 8 weeks each. Typically, a psychiatrist diagnoses TRD.^2,3

5 signs you might have resistant depression

Look for these signs. If you have any of the following, contact your doctor. Together, you can find the right therapies.

Symptoms that do not go away, even with treatment

You may have been taking medicine for your depression for about a month. Have you seen any improvement in symptoms? If not, you might have resistant depression. Your healthcare provider may adjust your dosage. They might switch medicines or try other therapies.^1-3

Perhaps you have already adjusted your dosage or switched medicines. If there are still no changes to your symptoms, you likely have TRD.^1-3

More severe symptoms

With resistant depression, symptoms may be more severe. These symptoms can include:²

• Persistent sadness
• Lack of energy
• Changes in appetite or weight
• Difficulty concentrating
• Thoughts of self-harm or suicide

If you have thoughts of suicide, get help. Contact the Suicide and Crisis Lifeline by calling or texting 988.²

More frequent and longer-lasting depressive episodes

People with resistant depression may have recurrent episodes. This can happen even after periods of remission. Despite periods of feeling better, the symptoms may return. They often come back with increased severity.^2,4

Anxiety

People with resistant depression are more likely to have anxiety too. A solution may be to prescribe you medicine that treats both your anxiety and depression.² 

Inability to find enjoyment or pleasure in life

People with TRD are also more likely to have anhedonia. Anhedonia is the inability to experience pleasure in things you once enjoyed.²

Factors that might be contributing to TRD

It is not clear what exactly causes resistant depression. But experts believe several things may contribute to its development. These include:^1-3

• Genetics – A family history of depression or other mental health disorders can increase the likelihood of TRD.
• Co-occurring mental health conditions – The presence of other mental health conditions like anxiety or substance use disorder can complicate depression treatment.
• Chronic stress – Prolonged stress can impact the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis plays a key role in regulating how the body handles stress. Experts think the HPA axis can get dysregulated. This may make a person with depression more resistant to treatment.
• Other medical conditions – Certain medical conditions can add to the complexity of depression. These include chronic pain, autoimmune disorders, thyroid issues, or heart disease.

Steps to take if you suspect treatment-resistant depression

Do you think you may have resistant depression? Here are the steps you should take to get help:^1,4

Talk with your doctor

Schedule an appointment with a mental health professional, such as a psychiatrist or psychologist. They will evaluate your signs, treatment history, and overall health. This helps determine the best course of action.^1-4

Consider additional testing

 
Those with diagnosed TRD might benefit from pharmacogenetic testing. This kind of testing analyzes a person’s genetic makeup to predict how they may respond to certain medicines. This testing can help identify which antidepressants are likely to be most effective. Remember that it is not a guaranteed fix. However, it can help reduce the trial-and-error process of finding the right drug(s).¹

Explore new treatment options

You can adjust your existing medicine or try a different type. However, there are other therapies to try. These can include:^1-4

• Psychotherapy – Also known as talk therapy, psychotherapy involves meeting with a trained therapist to discuss and work through emotional and mental health issues.
• Transcranial magnetic stimulation (TMS) – A noninvasive procedure where magnetic fields stimulate the cells in the brain. TMS helps regulate mood by altering brain activity in areas associated with mood regulation.
• Electroconvulsive therapy (ECT) – ECT involves passing small electric currents through the brain to intentionally trigger a brief seizure. ECT changes brain chemistry and has been shown to improve mood and provide relief from symptoms.
• Vagus nerve stimulation (VNS) – VNS involves implanting a device in the chest that sends electrical impulses to the vagus nerve in the neck. It helps regulate mood and reduce symptoms of depression by influencing the mood centers in the brain.
• Deep brain stimulation (DBS) – DBS is a surgical procedure where electrodes are implanted into specific areas of the brain to deliver electrical impulses. DVS helps with a variety of mood and neurological issues, including TRD.

Finding the right treatment path for you

Overcoming treatment-resistant depression requires time, patience, and persistence. Be open to trying new approaches. There are still therapies you can try. This could mean increasing or adjusting your current dosage. You might switch medicines or add another medicine. Talk with your doctor to get the help you need.¹