What is Treatment Resistant Depression & What are its Common Treatments?

Each and every person in this world goes through ups and downs in life and thus feels high and low; but when this feeling of depression or sadness persists for two weeks or more constantly then it is categorized under the clinical symptoms of depression. Patients with foremost depression symptoms usually respond to the general mode treatment for depression but 10-30% of patients show unsatisfactory improvement to at least two antidepressant treatments. Such patients suffer from Treatment Resistant Depression or TRD. It is a very serious and existent health ailment and about 20 million American citizens suffer from this every year.

What is Treatment Resistant Depression or TRD?

What is Treatment Resistant Depression or TRD?

Treatment Resistant Depression or TRD also known by Treatment-Refractory Depression is actually clinical psychic diseases under the instances of Major Depressive Disorder or MDD. Treatment Resistant Depression occur when patients do not response at all to at least two antidepressant therapies or medications and accompanied by other impairment like suicidal thoughts and attempts; very high rate of relapse; tendency to self-injury; deterioration of physical health and social behavior. Treatment Resistant Depression patients usually have relapse in the symptoms in a year and experience long-term poor quality life.

Factors Disposing Treatment Resistant Depression

Long-term researches for years have revealed the actual risk factors involved for the cause of Treatment Resistant Depression. Some of them include:

  • Duration of an Episode of Depression: As the duration of episodes become longer, the more impairment will happen in the brain structure mainly in the hippocampus area and in the behavior and cognitive alteration in such a way that normal condition cannot be reached well.
  • Acuteness of the Episode: Depression spectrum ranges from mild to most severe and offer to elevate the risk for unimproved response. Most severe depressions are related with symptoms such as biological imbalance, anxiety, restlessness, irritability, insomnia, very low drug versus palliative response, difficulty in concentrating and making decisions.
  • Depressive Symptoms: In many cases Treatment Resistant Depression is associated more with bipolar depression than any other MDD but the peak symptom is psychological mania. Others include: guilty feeling, loss of appetite, awaking early or oversleeping, fatigue, helplessness feeling, etc.
  • Comorbidity: Generalized anxiety disorder or symptoms makes the Treatment Resistant Depression treatment response much lower or sometimes very much harder to treat. It has been seen that comorbid anxiety related symptoms like personality disorder along with Treatment Resistant Depression can result in long-time taken for recovery, poor quality response to treatment, variable drug trials and relapses and recurrence frequently within the first year of treatment.
  • Age and Genes: Older age and variation in genes with serotonin transporter have also proved to be the most common risk factors for Treatment Resistant Depression.

Common Treatment for Treatment Resistant Depression

  • Medications: Medicines can help you to ease your depression problems but finding proper and exact medicines to treat Treatment Resistant Depression can require some more time. Dose of the medicines also play a key role in the treatment of Treatment Resistant Depression symptoms. However, after starting medication prescribed by your doctor keep up your patience, be mentally strong and don’t give up easily. Some common class of antidepressant medicines include: SSRI (Celexa, Praxil, Zoloft); SNRI (Pristiq, Effexor); serotonin receptor inhibitors (Viibryd, Brintellix); novel class of antidepressant affecting dopamine and norepinephrine levels (Remeron, Wellbutrin) and finally MAO inhibitors (Nardil, Marplan)affecting a special type of enzymes secreted by brain cells. Researches have shown that switching from one drug to another of the same class or from one class of drug to another class can result in significant well-being of a Treatment Resistant Depression patient.
  • Counseling: Cognitive behavioral therapy including counseling may help to cure depression especially to those suffering from Treatment Resistant Depression. If any patient has already undergone this therapy but acquired no effect then he can also choose for this therapy again after few years. As per doctor’s advice he can go for group therapy as well.
  • Electroconvulsive Therapy or ECT: It is a type of neurostimulation and used for serious life-threatening depressive symptoms that haven’t improved after several antidepressant medications. Electrodes are applied over the brain to regulate the seizures and ECT treatment continues at an interval of 6-12 weeks.
  • Vagus Nerve Stimulations or simply VNS: This is another form of neurostimulation and is ideal for treating recurrent or longer term depressive symptoms for those whose symptoms didn’t improve after more than 4 antidepressant medicines. A device is surgically fixed in the chest that can send electrical signal to brain. It takes about 9 months to show the effect and is seen effective in around 1 in 3 people.
  • Transcranial Magnetic Stimulation or TMS: It is a non-invasive electric-stimulating approach to treat TRD. This therapy is used to treat acutely depressed patient who have resistance to drug therapy. This therapy is implicated for 4-5 days a week and has side effects and is generally non-effective for most instances.
  • Future Therapies: Researches are advancing to find more advanced neurostimulation cures such as deep brain stimulation (DBS) or magnetic stimulation therapy (MST).

Ways to Live Better with Treatment Resistant Depression

A person with treatment resistant depression might find it difficult to cope with the situation. Here are some quick tips which will help one to understand things to be done to live better when they have this condition. Let us have a look at them.

  • Notify Your Family and Friend that you are Depressed: Just simply chat or notify your friends or loved ones that you feel lonely and depressed. You may not feel easy to say this to your near and dear ones; however, sharing the feelings helps others to understand you. Never be harsh on yourself about your feelings.
  • Remember Cure for Depression takes Time: You may try for antidepressant medicines but at the same time you may feel that the medicine is not working properly. However, be patient as these antidepressant medicines take little time to show the actual effect. Still if you have any confusion you can consult with your physician.
  • Find the Helpful Person to Talk about Your Thoughts: Everyone may not understand about your feelings or the depression symptoms. Just look for a person, a family member or a friend, with whom you can share all your thoughts and feeling.
  • Maintain Low-stress Activity: Try to maintain a regular and proper schedule for your regular work. This can include time for all your daily chores. Most importantly do not take too much stress as that could aggravate your condition.
  • Take Proper Diet and Enough Sleep: Try to take healthy and a balanced diet even if you are fit and healthy. A balanced diet containing all proteins, vitamin, minerals and carbohydrate are good for brain and body. Also one needs a proper 7-8 hours of sleep. Adequate sleep is the only medication to prevent any type of mental illness.
  • Recall your Hobbies and Interests: Whenever you feel depressed or lonely just try to recall your hobbies or interests. This means whatever you enjoy doing just go for it at the time of your sadness. This not only prevents any mental disorder but also make you feel happy.
  • Meditate Regularly: Regular meditation and yoga prevents the remission of depressive symptoms. You can practice even aerobics along with long deep breathing exercise.
  • Try to Celebrate Every Small Achievement: Always try to celebrate your own small achievement. This will boost up your mental strength and prevent you from feeling depressed.
  • Stay Organized and Tidy: Whenever you feel out of control or unorganized, you can clean up your surrounding spaces. Throw away all the unwanted things, clutter and paper and arrange the things that you need. This tidiness feeling can make you feel out of depression.


Although there is no strict scale of measuring the response of the treatment or remission of the Treatment Resistant Depression symptoms, still there are about thousands of patients with Treatment Resistant Depression whose symptoms are consistent. Treatment Resistant Depression is difficult to treat due to its nature to resist the treatment methods. Thus, mental health professionals always keep trying with newer and varied types of therapies and medications to find the exact method that helps the patient to improve. However, the patient’s and their family’s cooperation is of utmost importance in this.

A person with treatment resistant depression can very often lose hope owing to the repeated failure of drugs and therapies to bring in relief. However, one must never lose hope and accept the condition and its symptoms as a part of life and quit treatment. Remember, longer the depression, harder it is to get relief. Although, it takes time to treat; treatment resistant depression can often be managed and the person suffering from it can also lead a better life when following the doctor’s advice and the above mentioned tips religiously.

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Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:November 14, 2017

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