What Is Treatment-Resistant Depression?

Most people have heard of major depression. Most people are aware that the standard treatment for depression symptoms is antidepressant medications, potentially switching between different classes of antidepressants long term.

However, with treatment-resistant depression (TRD), which can look like major depressive disorder, there is often no reprieve from the depression symptoms, making these options unsuitable for treating depression of this magnitude.

The Center for Disease Control (CDC) estimates that treatment-resistant depression is a leading cause of disability across the globe, with as many as one in five adults experiencing at least one medication-resistant depression episode in their lifetime. As you can guess, having treatment-resistant depression can make management and recovery very difficult to obtain.

What is Depression?

It is common to presume that depression is similar to simply feeling sad a lot. For many people who suffer from a persistent depressive episode, this is not an accurate description. Indeed, when many people state that they are depressed, what they actually mean is that they are feeling sad. Hence, the term depression has become somewhat overused to describe something else in society.

It is true that persistent sadness can be a symptom of depression and treatment-resistant depression, but for many people who experience these symptoms, it is so much more. 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." 

So, depression, and especially treatment-resistant depression, is far worse than simply having a few days of feeling a bit blue. It can impact someone's personality and cognition and can also present with physical symptoms, such as migraines, stomach cramps, and insomnia.

Symptoms of Depression

What are some of the symptoms of depression? They can vary based on someone's age, genetic predisposition, and their current situation. 

However, some of the most common symptoms of depression and treatment-resistant depression to look out for include the following:

• Persistent sadness or an empty feeling mood.

• Loss of interest or pleasure in hobbies and activities that were once enjoyed.

• Dramatic changes in appetite or weight.

• Mood swings or feeling up and down suddenly.

• Guilt over life and regret.

• Insomnia or hyposomnia.

• A negative outlook on life.

• Low self-esteem and confidence issues.

• Loss of energy or increased fatigue.

• Irritability, restlessness, or anxiety attacks.

• Difficulty concentrating and lack of cognitive function.

• Feeling hopeless and helpless.

• Recurrent thoughts of death or suicidal ideation.

• Apathy and feeling flat.

As mentioned before, many people who experience depression may also experience physical symptoms, especially with treatment-resistant depression. These can include headaches, migraines, abdominal pain, muscular aches, nausea, and even feeling hot or cold.

What Causes Depression?

There has been some debate over the years between psychologists and psychiatrists as to what causes intractable depression and what can make it treatment-resistant. The most predominant theory is that it is linked to brain chemistry, including serotonin, dopamine, and norepinephrine. 

The treatment options in medicine for treating depression include antidepressants, which can present with unpleasant side effects or a poor response to treatment for many people. Even in cases where an individual has treatment-resistant depression, electroconvulsive therapy (ECT) may be used, but this is not a preferred option, as it induces an epileptic fit, which can have secondary side effects like memory loss.

Treatment-Resistant Depression

So, when is someone likely to receive a diagnosis of treatment-resistant depression? If someone has had medication-resistant depression for over two years and has tried at least two medications with minimal to no effect on symptoms, many psychologists and psychiatrists constitute this as treatment-resistant depression. For other mental health professionals, they feel it may be linked to how many therapies a person has been through, like cognitive behavioral therapy, but haven’t found success or reprieve from their symptoms.

There is then also the question of why some people develop these issues or why an effective treatment cannot be found. It may be that depression is comorbid and part of another disorder, such as bipolar disorder, borderline personality disorder, or PTSD. This can make treatment difficult and may require a different approach to the traditional methods to treat depression.

Alternative Treatments

There are some alternative treatments that can help with treatment-resistant depression. One is transcranial magnetic stimulation, where brain stimulation is used to help boost the brain tissue to correct the chemical imbalance that is causing the depression. This may or may not be successful and is dependent on the severity of the depression. Another option is ketamine treatment, which certainly comes with the most FAQs of any of the treatments for depression.

Final Thoughts

If you have had treatment-resistant depression for a while, it can be very disheartening. However, scientists, mental health experts, and psychiatrists are looking into different treatment options to help those who have TRD, which may include mixing ketamine treatment with therapy and traditional options. So, the right solution for you is out there!