Treatment-resistant depression (TRD)

What is treatment-resistant depression?

Sometimes, no matter what strategies are employed to try to manage depression, the symptoms don’t seem to respond.  Individuals who have not yet seen improvement after trying numerous individual medications and/or psychotherapeutic treatment approaches are often characterized as having treatment-resistant depression (TRD).

Mental health professionals are now recognizing that TRD occurs among a significant percentage of people struggling with depression.  As awareness of TRD has increased, so have the new approaches emerging to address this condition. TRD can be treated.  

How is treatment-resistant depression addressed?

To determine whether depression is treatment-resistant it’s important to first talk with your healthcare provider to confirm that your diagnosis is correct and that other health issues are not being overlooked.  You and your healthcare provider must also devote sufficient time to fully exploring several different courses of evidence-based treatment. This includes trying the most common medications and forms of psychotherapy, individually and in combination, and allowing ample time to observe the outcome of each course.  Determining “adequate dose” and “adequate duration” of both medications and psychotherapy are key starting points.

In recent years, large-sample clinical trials have suggested that starting with two medications may be advisable. These include mood stabilizersand antipsychotic drugs. Another option which has been proven effective in helping patients who have not responded to medication-based treatment is the use of electroconvulsive therapy (ECT), which is classified as a neuromodulation treatment.  Other neuromodulation treatments that may be employed include repetitive transcranial magnetic stimulation (rTMS)vagus nerve stimulation (VNS) and the experimental approach called deep brain stimulation (DBS).