Treatment Resistant Depression

Treatment Resistant Depression is often when your depression doesn’t respond to two or more adequate trials of different classes of antidepressants over a period of two years and fails to alleviate your symptoms. Standard treatments aren’t enough and the depression symptoms seem to worsen with each failed attempt.  

It can be very overwhelming and disheartening to receive a TRD diagnosis. Additionally, a TRD diagnosis often comes after a lengthy demoralising process of trying different medications and enduring various unpleasant side effects, only to find that the medication doesn’t have the desired effect.

It is important to know that TRD does not mean that your depression is ‘not real’ or ‘not legitimate.’ It just means that for whatever reason your brain has not responded to the first lines of treatment. It is not your fault.

Living with TRD is hard enough, but individuals with TRD can sometimes experience compassion fatigue from those around them. It can be very difficult for others to conceive of an emotional pain that is so persistent. When others cannot understand, it is particularly important to be compassionate and understanding towards yourself and your struggle.

What are the characteristics of TRD?

• Failed response to multiple classes of antidepressants
• Inability to tolerate anti-depressants at therapeutic does often due to serious side effects
• Worsening symptoms of depression
• Persistent suicidal thinking
• Hopelessness
• Mood swings
• Isolation
• Chronic emptiness
• Inability to experience pleasure and achievement
• Nil motivation
• Punitive thinking
• Numbness and using maladaptive behaviours such as deliberate self harm to feel something
• Low self worth/ self esteem
• Persistent feelings of sadness
• Irritability
• Low energy
• Decrease is libido
• Weight gain or loss
• Poor memory and concentration
• Restlessness

What are the causes of TRD?

There is no one reason for treatment resistant depression. It is often caused by a combination of environmental and genetic factors. The risk factors are:

• Depressive episodes that are longer in duration  
• Severity of the depressive episode
• Comorbid mental health conditions
• Age
• Biological Factors - genetics
• Stress
• Medications previously used to treat depression and anxiety  
• Trauma
• Abuse
  

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Major Depressive Disorder (MDD) vs TRD?

There are numerous similarities between MDD and TRD. They both impact on a person’s day to day functioning and consequently this interferes in all aspects of their lives such as relationships, health, work, study and home life. Further, similar symptoms are experienced both by those with MDD and TRD. However, the difference between the two is that TRD doesn’t respond well to medication and therefore, various medications may need to be trailed along with using a combination of therapy and procedures to treat TRD.

What Treatments are Available for TRD?

It is important to know that there is hope for individuals living with TRD as there are a number of treatment options. Firstly, it can be treated with a combination of medication and therapy. These therapies are Cognitive Behaviour Therapy (CBT), Dialectical Behaviour Therapy (DBT), Radically Open Dialectical Behaviour Therapy (RO-DBT), Acceptance Commitment Therapy (ACT), Psychotherapy, Interpersonal Therapy, and group therapy. Secondly, there are a number of procedures that can be used to treat depression including Repetitive Transcranial Magnetic Stimulation (rTMS), Electroconvulsive Therapy (ECT), and Vagus Nerve stimulation (VNS). These treatments are generally administered by a psychiatrist.

If you have TRD, it is ideal to have a treatment team, especially a psychiatrist, with a special interest in TRD.

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