Understanding Treatment-Resistant Depression

If you’ve been diagnosed with depression and have been battling it for years, you could have a difficult-to-treat form of depression called refractory or treatment-resistant depression (TRD). While it can feel overwhelming to continue feeling depressed despite receiving treatment, there are treatments available that can bring symptom relief. With some general knowledge of TRD, you can learn to recognize the symptoms and avoid suffering for years before receiving an official diagnosis and proper treatment.

What is Treatment-Resistant Depression?

While widely accepted as a form of depression, experts still debate the actual definition of TRD. It’s generally considered depression that doesn’t respond to antidepressants, but there isn’t an established number of medications or drug classes you must fail before you have TRD. You should speak to your mental health provider if you experience any of the following:

  • Little to no relief from prescribed antidepressants
  • Reduction in depressive symptoms, but don’t feel like yourself
  • Brief bouts of relief followed by a return of depressive symptoms
  • Inability to handle the antidepressant’s side effects
  • More frequent, longer, or worsening episodes of depression

If you’ve explored each treatment fully and are losing hope that you won’t ever be able to live without depression, there’s a good chance you have TRD. While general practitioners can prescribe antidepressants, you should consult a psychiatrist if you suspect you have treatment-resistant depression, as it can be challenging to diagnose.

What Increases Your TRD Risk?

TRD tends to be more likely if your depression has an early onset, meaning the symptoms emerged when you were young. If you have frequently recurring episodes or your depression lasts for a long time, you are more at risk for TRD. The same goes for severe cases of depression.

However, several factors may make your depression resemble TRD when it may not be:

  1. Not taking your medications as prescribed, skipping doses, taking them at the wrong time, with the wrong foods, etc.
  2. Not having a mental health professional managing your care appropriately; your dose could be too low for you, so you aren’t feeling the effects. You and the provider must check in to ensure you don’t need a dosage change.
  3. Frequently switching medications before giving them the whole time to have a therapeutic effect.
  4. Hypothyroidism can present as depression, but antidepressants won’t provide relief.
  5. Bipolar disorder: antidepressants help but won’t completely treat the condition.
  6. A concurrent diagnosis for another physiological or psychiatric condition. Depression can be harder to treat without simultaneously receiving treatment for the other issue.

What Treatments Are Available For TRD?

Unfortunately, depression treatment is highly individualized. No two antidepressants work in the same way, just as no two people respond the same way to the same treatment. Luckily, there are many treatment options beyond antidepressant drugs. You should know all of your treatment options:


Talk therapy comes in many forms. While cognitive-behavioral therapy (CBT) tends to be the favorite for TRD, this branch has different styles. For example, acceptance and commitment therapy is part of CBT, but it’s more focused on you adopting positive behaviors. You perform these behaviors when negative emotions or thoughts enter your mind.

Some patients benefit more from group therapy instead of one-on-one. Others prefer interpersonal psychotherapy to work on their relationship issues. Relationship struggles, communication issues, and toxic patterns frequently increase stress and tie into depression.

Lifestyle Modifications

Changes to your diet, exercise routine, or work environment can go a long way in helping your depression. Slowly engaging in activities you used to love, even if you don’t want to, can boost your overall mood. This is called behavioral activation and can help you feel less isolated in your depression.

Electroconvulsive Therapy (ECT)

While ECT can help TRD, mental health professionals reserve it for patients that are a danger to themselves. You must have ECT in a hospital operating room under general anesthesia. An electrical current runs through your brain to set off small seizure activity to restore normal functioning. You can suffer short-term temporary or permanent memory loss, so most patients don’t consider it until other treatments are not working.

Vagus Nerve Stimulation (VNS)

Like ECT, this treatment provides electrical stimulation to your brain to relieve your TRD. However, surgeons implant a device in your body for long-term treatment. VNS isn’t an option until you’ve failed at least two complete antidepressant trials.

Transcranial Magnetic Stimulation (TMS)

Unlike ECT, VNS, and antidepressants, TMS is non-invasive and non-systemic. MRI-strength magnets stimulate parts of your brain responsible for mood and emotions via a coil on your scalp. You have treatments five days a week in an outpatient clinic for several weeks. The side effects are minimal to non-existent since your treatment is only on your brain without anesthesia or electrical stimulation. You can suffer a minor headache or scalp irritation that is relieved by over-the-counter pain medication.

While studies support that TMS is an effective treatment option for TRD, a newer form may have even better treatment outcomes. For example, one study on Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) TMS for treatment-resistant depression had 90% of participants meet remission criteria after treatment.

If you think or know you have TRD, it’s important to remember you have treatment options. While TRD doesn’t typically respond enough to drug therapy, there are newer treatment methods with much higher success rates. You can have TMS in conjunction with nearly every other treatment option, so sometimes it’s the missing link in your treatment regimen to push you over the edge into complete remission. No one should have to live with depression symptoms; speak to your provider about your options for treatment today.