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  • Writer's picture Sara Provence

What Is Treatment-Resistant Depression?

Updated: Oct 27, 2023


Depression is a serious mental illness that can devastate a person’s life. According to the Centers for Disease Control and Prevention (CDC), depression is a leading cause of disability across the globe. It is estimated that 1 in 5 adults in the United States suffers from depression. Traditional treatments like psychotherapy or antidepressants fail to alleviate depressive symptoms for 1 in 3 adults. This unresponsiveness to treatment is what gives ‘treatment-resistant depression” its name. What Is Depression?

Many people confuse depression with sadness. When someone says, “I’m depressed today,” what they likely mean is, “I am sad.” And if they’re not depressed, their sadness more or less matches the importance of whatever they’re sad about. While it is true that sadness is one of the symptoms of depression, there is much more to it. Professor of Psychology at Columbia University, Andrew Solomon, describes the confusion poetically in his book Noonday Demon, “Grief is depression in proportion to the circumstance; depression is grief out of proportion to the circumstance.” Depression is more than just feeling blue. It is a mental illness that can lead to serious changes in a person’s mood, thoughts, behavior, and physical health.

Symptoms of Depression Depression shows up in a variety of ways depending on individuals’ genetics, history, and current situation, but some common signs to watch for are:

  • Persistent sadness or empty mood

  • Loss of interest or pleasure in previously enjoyed activities

  • Dramatic changes in appetite or weight

  • Mood swings

  • Guilt

  • Insomnia

  • A negative outlook on life

  • Low self-esteem

  • Loss of energy or increased fatigue

  • Irritability, restlessness, or anxiety

  • Difficulty concentrating

  • Feeling hopeless and helpless

  • Recurrent thoughts of death or suicide

It’s also important to note that depression can cause physical problems such as headaches, stomachaches, and back pain, sometimes even leading to substance abuse and other risky behaviors.

What Causes Depression?

There is no single cause of depression. Rather, it is believed to be caused by a combination of genetic, biological, psychological, and environmental factors. Depression can run in families, and scientists have identified over 100 gene variations linked to the disorder. This suggests that depression has a strong hereditary component. However, genes are not the only factor involved. Other possible causes of depression include:

  • Major life changes or trauma, such as the death of a loved one, divorce, or loss of livelihood

  • Certain medical conditions, such as a thyroid disorder, cancer, or chronic pain

  • Certain medications, such as those used to treat high blood pressure or birth control pills

  • Substance abuse

  • Poor nutrition

  • Certain personality traits, such as low self-esteem or being overly dependent on others

Treatment-Resistant Depression

Experts disagree on exactly what constitutes treatment-resistant depression. There are two prevalent camps of thought. The primary disagreement is around how many failed methods of treatment a person has under their belt. One camp asserts that a person only needs to have received two different treatments that were ineffective, while the other camp calls for at least four failed treatments before issuing a diagnosis for treatment-resistant depression. There are many possible reasons why a person may develop resistance to depression treatments. It could be due to co-occurring disorders, the severity of their condition, the type of depressive disorder, or how their body responds to medication.

Alternative Treatments

Several alternative treatments have shown positive results in treating TRD. These include ketamine therapy, electroconvulsive therapy, transcranial magnetic stimulation, and vagus nerve stimulation. However, ketamine therapy has stood out as the most promising alternative treatment for severe and treatment-refractory depression. Over the past 50 years, ketamine’s role in health has evolved dramatically. What was once primarily a surgical sedative has become an invaluable resource for various physical and mental issues, known both for its transformative power and immediate results. Multiple studies show that low-dose ketamine infusions can rapidly reduce depressive symptoms within hours or days, even in people who haven’t responded to other treatments.

Final Thoughts

Having treatment-resistant depression can be incredibly frustrating and discouraging. However, it does not mean you’ll never find relief. A mental health professional can help you explore different treatment options and develop a treatment plan that works for you. Remember that if one treatment doesn’t work, you can always try a different approach. Scientists across multiple disciplines are working on more innovative solutions for depression and mood disorders, with ketamine showing particularly powerful results.

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