Treatment Resistant Depression

Treatment Resistant Depression (TRD) is a term often used when your depression doesn’t ease after two or more adequate trials of antidepressants. It can feel as though standard treatments aren’t enough, and the depression can seem to get worse with each attempt that doesn’t help. Some clinicians now say difficult-to-treat depression.  

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 people 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 what you are going through.

What are the characteristics of TRD?

• Not responding to several types of antidepressant
• Finding antidepressants hard to tolerate at therapeutic doses, often due to serious side effects
• Depression that is getting worse
• Persistent suicidal thoughts
• Hopelessness
• Mood swings
• Isolation
• Ongoing feelings of emptiness
• Finding it hard to feel pleasure or a sense of achievement
• Very low motivation
• Harsh, self-critical thinking
• Numbness, and sometimes using self-harm to feel something
• Low self-worth/self-esteem
• Persistent feelings of sadness
• Irritability
• Low energy
• Decrease in libido
• Weight gain or loss
• Difficulty with memory and concentration
• Restlessness

What are the causes of TRD?

There is no one reason for treatment resistant depression. It often comes from a combination of environmental and genetic factors. Risk factors include:

• Depressive episodes that are longer in duration  
• Severity of the depressive episode
• Co-occurring 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, people with MDD and TRD have similar experiences. However, the difference between the two is that TRD doesn’t respond well to medication, and therefore various medications may need to be trialled, along with a combination of therapy and medical procedures.

What Support is Available for TRD?

It is important to know that there is hope for people living with TRD, as there are a number of options. Firstly, a combination of medication and therapy can help. These therapies are Cognitive Behaviour Therapy (CBT), Dialectical Behaviour Therapy (DBT), Radically Open Dialectical Behaviour Therapy (RO-DBT), Acceptance and 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 care team, especially a psychiatrist, with a special interest in TRD.

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