In the past decade, the percentage of young adults experiencing anxiety or depression has increased significantly. Recent analysis shows that in 2023, almost half of all adults ages 18 to 24 report having experienced symptoms of major depressive disorder. Each year, over 30% of people with depression develop treatment resistance — also known as treatment-resistant depression or TRD.
With so many young people struggling with depression and so many patients unable to find relief from depressive symptoms, the demand for effective alternative treatments have increased dramatically. Psychiatrists, researchers, pharmacologists, among other mental health professionals have made great strides in developing new antidepressant medications and alternatives to standard oral antidepressant medications to better treat those with treatment-resistant depression.
Here’s what treatment-depression looks like and alternative care options to get you on the path toward better mental health, sooner.
How Is Treatment-Resistant Depression Different from Traditional Depression?
Treatment-resistant depression is a term used to describe a form of major depressive disorder that does not respond adequately to standard treatments. Medication and talk therapy are typically used as first-line treatments for mood and anxiety disorders. However, only approximately 50% of people will achieve remission after two medication trials, with each subsequent trial having a higher risk of intolerable side effects and a lower likelihood of achieving remission.
In some cases, individuals with depression may not experience significant symptom relief despite these conventional treatments. When patients have tried one or more antidepressant medications or other evidence-based therapies, but their depression symptoms persist or return, they can be diagnosed with treatment-resistant depression.
Causes of Treatment-Resistant Depression
If you have treatment-resistant depression, it’s important to remove feelings of guilt or shame about this mood disorder. There are many elements at play that are out of your control, so here are some factors of treatment-resistant depression.
Biological factors
Some individuals may have specific genetic or biological factors that make their depression more resistant to treatment. Research suggests that these risk factors may include older age and fast or slow metabolization speed.
Severe depression
If you are noticing little to no improvement with traditional care methods to treat depression, you may have major depression or major depressive disorder. Other types of depression that exhibit treatment resistance include:
- Bipolar depression.
- Unipolar depression.
- Treatment-refractory depression.
- Persistent Depressive Disorder (formerly known as dysthmia).
- Comorbid depression.
- Inflammation-associated depression.
Major depressive orders that come with specific features, such as MDD with psychotic features and MDD with anxious features, are also known to have an inadequate response to traditional treatment.
Underlying medical conditions
Certain physical health conditions — such as thyroid disorders or chronic pain — can contribute to treatment resistance. These conditions may directly affect brain chemistry or create ongoing stress that undermines typical treatment modalities. Comprehensive medical evaluation, including laboratory testing and physical assessment, is often essential for identifying these underlying factors that may be silently perpetuating depressive symptoms.
Co-occurring mental health disorders
If an individual has other mental health disorders alongside depression, such as anxiety, mood disorders, or substance abuse, it can complicate treatment and make it more challenging to achieve relief. These co-occuring conditions often interact with depression in complex ways, each reinforcing the other in a cycle that requires integrated treatment approaches. Addressing all conditions simultaneously through a coordinated care plan that targets their interconnected nature is generally more effective than treating each condition in isolation.
Incorrect or Inadequate Diagnosis
First, it’s important to confirm a correct diagnosis of depression. A failure to correctly and precisely identify the actual subtype of depression, such as atypical, psychotic, bipolar, or melancholic depression, can impact treatment outcomes. Misdiagnosis may also include failure to identify a comorbid medical condition, including hypothyroidism, anemia, substance abuse disorders, or eating disorders, which can worsen depression or may be the underlying cause of the treatment-resistant depression.
Other times, a patient may not comply or adhere to their prescribed treatment. Not staying on prescribed antidepressants long enough, skipping doses, unpleasant antidepressant side effects, and drug interactions can all lead to a treatment-resistant depression diagnosis.
Related: Lexapro for Depression
Signs and Symptoms of Treatment-Resistant Depression
To understand signs and symptoms of treatment-resistant depression, see if you exhibit any of these symptoms of traditional depression:
- Excessive sadness or tiredness.
- Loss of interest in activities that once brought you joy and fulfillment.
- Frequent sleep disturbances.
- Difficulty concentrating.
- Unexplained weight loss or gain.
If you exhibit any of the symptoms and are in therapy, taking medication to manage your depression, or engaging in another treatment modality, look out for signs that your form of depression isn’t responding to treatment. These symptoms include:
- Lack of response to multiple medication trials or various prescribed medicines and medication strategies.
- Worsening symptoms of depression.
- Worsening side effects with each failed treatment attempt.
- Feeling increasingly hopeless about treatment outcomes.
- Persistent functional impairment in work, relationships, or daily activities.
If you or a loved one suspects you may have treatment-resistant depression, it’s important to get diagnosed accurately. Some people with bipolar disorder, substance use disorder, or thyroid disease are misdiagnosed with treatment-resistant depression. A medical evaluation can also rule out important comorbidities including pancreatic cancer, hormonal etiologies like low testosterone and perimenopause, or possible deficiencies in Vitamin B12, Folate and Vitamin D.
For those diagnosed with treatment-resistant depression, there is no single cause. Rather, treatment-resistant depression has been associated with several different risk factors. The following factors may increase a person’s risk of experiencing treatment-resistant depression:
- Long depressive episode duration.
- Mild or very severe depressive episode.
- High number of stressful life events and traumas.
- Melancholic features including lack of reactivity to positive news and events, feelings of deep despair or worthlessness, weight loss and excess guilt.
- Advanced age.
- Genetic variants.
Care Options for Treatment-Resistant Depression
If antidepressants and talk therapy aren’t working for you, you’re not alone — and it doesn’t mean you can’t feel better. But, it does mean you should try a different treatment.
Can precision prescribing help treatment-resistant depression?
There are many types of antidepressants and it can be difficult to predict how well a particular medication will help an individual. Often, doctors first suggest taking a medication that they consider to be effective and relatively well-tolerated. If it doesn’t help as much as expected, it’s possible to switch to a different medication and sometimes a number of different antidepressants have to be tried before you find one that works. Currently, this trial-and-error prescribing of antidepressants is a contributing factor in treatment failure.
Precision prescribing uses genetic information to help patients avoid the trial-and-error process. With precision prescribing, DNA samples are taken with cheek swabs and sent out to a laboratory. The results may help clinicians and patients rule out medications that, for genetic reasons, will be less effective or that may lead to more side effects.
Studies have shown that patients with treatment-resistant depression are 30% more likely to respond to treatment and 50% more likely to achieve remission when their medication selection is guided by a psychotropic genetic test.
Safe and effective treatment alternatives for treatment-resistant depression
There are many safe and highly effective treatment alternatives for those with treatment-resistant depression. The goal of depression treatment is to alleviate symptoms and provide relief for the mental health condition.
Transcranial Magnetic Stimulation (TMS) therapy
Transcranial magnetic stimulation (TMS) therapy is a drug-free, FDA-cleared treatment that delivers gentle magnetic pulses to promote deep brain stimulation and treat mood at its source. Unlike medications which can take 6 to 8 weeks to exert their full effects, most patients experience improvement in 2 weeks with TMS therapy.
TMS for depression is not the same thing as electroconvulsive therapy; it’s much safer. TMS works by utilizing magnetic fields to stimulate nerve cells in specific regions of the brain associated with depression. This noninvasive and repetitive procedure is often recommended when treatment-resistant depression is diagnosed. By delivering focused magnetic pulses to targeted areas, TMS aims to modulate brain activity and alleviate depressive symptoms. When managing treatment-resistant depression, TMS therapy emerges as one of the most effective alternative treatments.
Related: TMS for Addiction Treatment
MeRT (Magnetic e-Resonance Therapy)
Magnetic Resonance Therapy, MeRT, is a revolutionary technology that combines the latest therapies of TMS (an FDA-cleared therapy), EEG, and EKG to deliver treatments tailored to each individual’s unique brain pattern. By measuring and analyzing your brainwave activity, MeRT assesses the communication quality between the neurons in your brain and custom designs treatment protocols to optimize brain function.
Psychiatric medication management
Medication management plays a crucial role in the treatment of individuals with treatment-resistant depression. When a patient shows resistance to conventional antidepressant medications, psychiatrists and healthcare providers specializing in mental health can place a patient on a treatment-resistant depression program to closely monitor the patient’s response to different depression medications, explore various classes of antidepressants, and adjust dosages as needed.
Additionally, healthcare professionals ensure that the patient adheres to the prescribed medication schedule, emphasizing the importance of consistency and reporting any side effects or changes in symptoms. Regular follow-up appointments are conducted to assess the effectiveness of the medication and make further adjustments based on the individual’s unique needs. At Neuro Wellness Spa, online and in-person psychiatrists can help with even the toughest cases of treatment-resistant depression.
Neuro Wellness Spa Can Provide Relief From Treatment-Resistant Depression
Don’t settle for a treatment that’s partially effective at helping relieve depressive symptoms or one that works but causes intolerable side effects. Neuro Wellness Spa can help you or a loved one who may be struggling with treatment-resistant depression. We are proud to offer a full range of mental health services, including adolescent psychiatry, talk therapy, and TMS therapy for treatment-resistant depression. Each of our treatments is designed to correct neurotransmitter deficiencies that cause depressive symptoms and teach you how to change negative thought patterns into healthier, more adaptable ones.
Our in-person and online psychiatrists will assess your symptoms and determine if medication management or TMS therapy is a good fit for you. Individual talk therapy is also available as a supplement to medications and TMS. If you or a loved one is experiencing depression signs or symptoms, contact us today to find out if any of our treatment-resistant depression treatment options are right for you.