How Can I Find Resources For Refractory Depression?
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Major depressive disorder (MDD)—also called major depression—is a serious mental health condition that can significantly impact an individual’s life.
If you’ve experienced major depression that doesn’t respond to conventional forms of care, you may have a condition known as treatment-resistant depression (TRD), also called refractory depression. Below, we’re going to provide an overview of treatment-resistant depression and discuss how you can find resources for addressing its symptoms
What is treatment-resistant depression?
Depending on the symptoms that an individual with major depression experiences, a healthcare professional may develop a treatment plan that includes psychotherapy, medication, or a combination of both. And while these standard modalities for managing depression are effective in reducing symptoms for most, some individuals do not respond as favorably, or at all, to them.
According to research published in the journal BMC Psychiatry, when consecutive treatments with two products from different pharmacological classes are used at the optimal dose for a sufficient length of time without an improvement in symptoms, the individual is considered to have treatment-resistant depression. It can be frustrating to experience this form of major depressive disorder, but if you believe you may have treatment-resistant depression, you’re not alone. It’s estimated that one-third of adults with depression experience symptoms that do not respond to treatment.
Finding resources for treatment-resistant depression
For patients with treatment-resistant depression, experiencing symptoms that do not respond to common forms of care can further complicate an already complex disorder. Often, though, TRD can be managed by developing a unique approach based on the individual’s symptoms, past treatments, and various other factors. If you’re looking to address treatment-resistant depression symptoms, the following are ways you can find resources geared toward managing TRD.
Working with a specialist
Because TRD can vary in intensity and may manifest differently between individuals, it can be challenging to diagnose. If you’re experiencing TRD, seeking the help of a psychiatrist or other mental health professional who focuses on depression can be a helpful first step toward managing your symptoms. There are multiple strategies specialists can use to determine whether TRD is the reason that treatment isn’t working for you.
A depression specialist can work with you to gather more in-depth information about your symptoms, medical history, lifestyle, etc. This can provide them with a more thorough understanding of the factors that may be influencing your symptoms and inform their development of a new treatment plan.
Your doctor will likely want to know what medications, if any, you’re taking for depression and other health conditions. Try to be as accurate as you can when discussing whether you’ve been taking your medications as prescribed so that the specialist can better evaluate their efficacy.
Your provider may want clarification on how you’ve responded to other types of treatment, including psychotherapy. They will likely also ask about other health conditions that may have exacerbated depressive symptoms or impacted the effectiveness of medication. Be sure to discuss any specific health conditions, like thyroid disorders, chronic pain, or heart problems, with your doctor.
Exploring medication strategies for treating TRD
If nothing seems to effectively treat your depression, a licensed clinical professional will consider the entire scope of your treatment plan, including medications, psychotherapy, and alternative treatments for refractory depression.
Medications for refractory depression may work differently for different people. A psychiatrist may work with you to find the right medication or the right combination of medications, as well as the right dosage for each medication. Some medicines take longer than others to become effective, so your doctor may ask that you try a particular medication schedule for an extended time. If you experience side effects, you might mention these so that your doctor can prescribe something that works better for you.
Specialists may also use a cytochrome P450 (CYP450) test to measure how effectively your medications are working. The cytochrome CYP450 is a genotyping test that identifies certain genetic indicators for how well your body may be able to metabolize a particular medication. Certain genetic traits cause variations in some cytochrome P450 enzymes, and that can cause people to respond to medications differently. While a CYP450 test can be a useful tool in helping to treat refractory depression, it doesn’t always guarantee clear answers. You should also be aware that insurance companies won’t always cover the cost of CYP450.
Exploring psychological counseling for TRD
Psychological counseling, which is also referred to as psychotherapy, is a type of treatment administered by a psychiatrist, psychologist, or other mental health professional. It can be a beneficial form of treatment for many people, either alone or in combination with medications. Your therapist will help identify underlying issues that may be contributing to your depression and set some goals for your treatment plan.
Psychological counseling may help to:
- Find ways that work for you to help you cope with your challenges.
- Identify and address any issues with past trauma.
- Find effective ways to manage the effects of stressors in your life.
- Help you to manage and improve essential relationships in your life.
- Help you to address any issues with substance use.
It’s important to communicate with your therapist about how well your psychotherapy is working. If the current treatment isn’t working, your therapist may decide to use a different form of psychotherapy. If your therapist changes your treatment plan yet you still seem to be lacking progress, try seeing a different therapist. A different therapist with a fresh outlook may be able to work better with your condition.
There are many types of psychotherapy used to treat symptoms of major depression. Your therapist will likely choose the modality they think will be most effective for you based on initial sessions with you and any information they received from your other healthcare professionals.
Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) addresses the thoughts, feelings, and behaviors that may contribute to depression. It is designed to help you identify and change any distorted or unhelpful thought patterns that may be underlying symptoms of depression. For example, your therapist may help you recognize that a negative attitude toward treatment causes you to feel less motivated and contributes to your low mood. CBT is considered one of the most effective forms of psychotherapy for depression.
Acceptance and commitment therapy
A derivative of CBT and traditional behavioral therapy, acceptance and commitment therapy encourages the individual to accept their thought patterns and feelings with the goal of understanding why they exist and how the mind uses them to cope with difficulty. With this understanding, they can then work on developing healthier, more productive behavioral patterns.
Interpersonal therapy
Interpersonal therapy focuses on resolving challenges surrounding your relationships that may contribute to refractory depression. For example, a therapist could help you realize that communication struggles between you and your partner cause you to internalize feelings of sadness and experience feelings of loneliness.
Group therapy
Group therapy is a form of counseling in which several people attend sessions at the same time, typically for the same concerns. When addressing treatment-resistant depression, it may help to participate in therapy with people who are experiencing similar challenges.
Brain stimulation therapies
In addition to the above options, treatments known as brain stimulation therapies have proven effective for many people with treatment-resistant depression. These modalities are typically only suggested for people with persistent, severe depression symptoms. If your healthcare provider is considering one of these treatments, they will likely spend a lot of time educating you on the risks, potential benefits, and processes involved. The following are the most common forms of brain stimulation therapy.
- Electroconvulsive therapy (ECT) – Electroconvulsive therapy is a form of brain stimulation in which a carefully measured amount of electricity is conducted through the brain to trigger a small, brief seizure. The seizure creates changes in brain chemistry that may relieve the symptoms of major depression.
- Repetitive transcranial magnetic stimulation (rTMS) – Transcranial magnetic stimulation is a process in which a magnetic field is used to stimulate areas in the brain that control mood to target depression symptoms.
- Vagus nerve stimulation (VNS) – VNS is a process in which a device sends signals through the vagus nerve, which is partially responsible for facilitating functions that can alleviate depression. Clinicians usually reserve this type of therapy when ECT and rTMS aren’t effective.
According to the National Institute of Mental Health, researchers are looking into other forms of treatment, such as deep brain stimulation and magnetic seizure therapy. You can ask a doctor about these and other forms of treatment for depression.
Lifestyle changes
As with many kinds of mental health care, treatment for refractory depression is often more effective when the individual is mindful of their physical health and practices self-care. There are many ways you can reduce the stress in your life and improve your chances of experiencing desirable long-term treatment outcomes. Try to get as much rest as possible, maintain a balanced diet, and get regular exercise. Self-care practices such as yoga, mindfulness, and deep breathing can also be beneficial.
Navigating refractory depression with online therapy
The results from a growing number of studies suggest that online therapy is an efficacious form of treatment for people with depression. In a meta-analysis of 14 studies examining the benefits of online cognitive behavioral therapy for depression, researchers concluded that treatment produces an “immediate and sustained reduction in depressive symptoms”. They also noted the ability of online therapy to bridge the treatment gap that often exists in mental health care due to barriers such as cost, geographical limitations, and time constraints.
If you’d like a new perspective on your depression symptoms, consider getting matched with a qualified mental health professional through BetterHelp. BetterHelp works with thousands of licensed therapists—who each have three years and 1,000 hours of hands-on experiences—so you’ll have a good chance of connecting with someone who can help you address your specific concerns regarding treatment-resistant depression. With online therapy, you can participate in sessions remotely, which can be helpful if refractory depression makes leaving home difficult.
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