Treatment Resistant or Refractory Depression

Treatment resistant depression is a severe depressive illness where the symptoms of depression do not respond to treatment or keep recurring. We can help.

What is treatment resistant depression?

There is some debate as to diagnosis criteria of treatment resistant depression, but in general if someone has tried antidepressants from two different classes and failed to respond, then it might be time to consider whether they have treatment resistant depression.

Treatment resistant depression is a very frustrating and distressing illness; sufferers and their families may feel huge relief that things seem to be getting better, only to be knocked back when they get worse again.

Curing treatment resistant depression

Despite its name, there are effective treatment options for treatment resistant depression, but it is important to get an accurate diagnosis to start with.

Bipolar disorder and psychosis are two diagnoses that may be considered when someone fails to respond to medication and treatment adequately.

It has also been suggested that patients who experience repeat episodes of depression should have another assessment to ensure that they haven’t developed another mental health condition that requires a different medication regime.

What causes treatment resistant depression?

We do not always know why some people have treatment resistant depression but the following factors could contribute:

1. Medication issues:

• Antidepressants can take up to three months to start working
• Not taking medication as prescribed can affect the way that it works, for instance not taking the correct dose or taking it at the wrong time of the day
• Stopping medication because of the side effects
• Stopping medication because it does not seem to be working
• Medications interacting with other substances, for instance alcohol, recreational drugs or other prescribed medications.
• The wrong dose or the wrong type of antidepressant – it can take a few attempts to find the correct type and dose of antidepressant

2. Underlying health issues:

• Other illnesses or issues can create depression including chronic pain, hypothyroidism, anaemia, heart problems, anxiety disorders, alcohol, substance abuse or other addictions.
• Misdiagnosis - if the incorrect illness is being treated then it is no wonder it seems 'resistant' and does not react to the medication taken. Other disorders such as bipolar disorder are commonly misdiagnosed as depression.
• Depression also occurs alongside other conditions such as panic or anxiety disorders or post-traumatic stress disorder.
• It may also be that another psychological condition is involved such as chronic fatigue.

Depression symptoms can be made worse by several factors, which might mean it is harder to effectively treat depression.

• Severe stress
• Eating disorders
• Lack of sleep
• Drug / alcohol usage

Treatment options for treatment resistant depression

There are options available for help with treatment resistant depression.

The most important step is to get a thorough assessment with an experienced psychiatrist, who will be able to rule out any underlying health issues and investigate any factors that might have been previously neglected.

Treatment options may include:

Medication review:

• Switching to new medication – 1 in 3 people do not respond to the first prescribed antidepressant. There is a range of other medication available.
• Reviewing the dosage levels
• Combining antidepressants with other medications such as antipsychotics or mood stabilisers.

Psychotherapy:

Talking therapies have been found to help improve the symptoms of depression. A study from 1997² found that for more severe cases of treatment resistant depression, treatment was more successful where psychotherapy and medication were combined than these treatments alone.

Read more here about talking therapies

²  Research gate

Other treatments for treatment resistant depression (not currently provided by Clinical Partners)

ECT:

Electrical currents are passed through the brain to trigger a seizure. There can be side effects such as confusion or temporary retrograde amnesia but for some patients ECT offers immediate relief of severe depression.

Transcranial Magnetic Stimulation:

Not currently available on the NHS due to costs, it applies magnetic fields to alter brain activity.