Help for Treatment-Resistant Depression
As many as 30 percent of people with depression don't respond to treatment. Find out what comes next if medication does not seem to be working.
By Chris Iliades, MD
Medically Reviewed by Lindsey Marcellin, MD, MPH
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Clinical depression is a serious health condition that affects more than 15 million American adults and is predicted to become the second most common health problem in the world by the year 2020. Although depression is a treatable illness, about 10 to 30 percent of people experience treatment-resistant depression.
"Treatment-resistant depression means that the individual has not responded adequately to treatments tried," explains Kathleen Franco, MD, professor of medicine and psychiatry at Cleveland Clinic Lerner College of Medicine in Ohio. This could mean that:
- Medication is not working at all
- Medication is only partially working
- Depression comes back while taking medication
What Causes Treatment-Resistant Depression?
"An accompanying physical illness is one reason why a disorder may be difficult to treat," says Dr. Franco. Common medical conditions that can lead to treatment-resistant depression include hypothyroidism and anemia. Other possible causes of treatment-resistant depression could be:
- Medications.Some drugs that are used to treat blood pressure such as methyldopa (Aldomet), reserpine (Serapsil), and the class of drugs known as beta blockers have been known to make depression more difficult to treat.
- Substance abuse.Abuse of alcohol or drugs or addictive eating disorders can interfere with depression treatment.
- Type of depression.Certain types of depression such as psychotic, bipolar, or atypical depression may be more likely to be treatment-resistant.
- Compliance.People who don't take their medications as prescribed or don’t take their medication because of side effects may be treatment-resistant.
Symptoms of Treatment-Resistant Depression
If you have any of these symptoms for more than two weeks despite being on antidepressant medication, you may have treatment-resistant depression:
- Feeling sad, anxious, or empty
- Feeling guilty, worthless, or hopeless
- Changes in sleeping or eating habits
- Loss of interest in pleasurable activities
- Loss of mental concentration
- Loss of physical energy
Diagnosis and Treatment of Treatment-Resistant Depression
Diagnosis of treatment-resistant depression should be considered if the patient has had no relief from depression symptoms, despite numerous treatments for established periods of time at the correct dose and frequency, says Franco. Although research shows that only one in three people with depression become symptom-free after the first medication they try, there are many options for treatment-resistant depression:
- Optimization.In many cases people with depression are not getting the best results from their first drug because the drug is not taken at a high enough dose or for a long enough period of time. A patient may need to take the medication for up to 10 to 12 weeks to get a full response.
- Substitution.Switching to a different class of antidepressant medication may help. Studies show that 30 to 50 percent of people with treatment-resistant depression responded well after substituting an antidepressant that works in a different way.
- Combination.Taking more than one type of antidepressant medication may help. Although combining antidepressant drugs works as well or better than substitution, there is the possibility of increased side effects.
- Psychotherapy.Adding talk therapy with a mental health professional can help. In a National Institute of Mental Health study, teenagers with treatment-resistant depression did better when they switched to a different type of antidepressant and added psychotherapy compared with just switching medication alone.
- Neurostimulation.This is a type of therapy in which electrical impulses are used to treat depression. Electroconvulsive therapy (ECT) is the most effective treatment for clinical depression that does not respond to other treatment. With ECT, electrodes are placed on the head to deliver electrical impulses. Another type of neurostimulation that has been approved for treatment-resistant depression is vagal nerve stimulation, in which electrodes are placed on the chest.
If you have treatment-resistant depression, don't give up. You may have to work with your doctor for a while to get the right medication or combination of medications and psychotherapy. Let your doctor know if you are having any side effects, and never stop taking medication on your own. Finally, remember that 80 to 90 percent of people with depression do get better.
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