About Treatment Resistant Depression (TRD)

By John M. Grohol, Psy.D.

Clinical depression can sometimes be difficult to treat. When a person has tried multiple types of treatment options to treat their depression (sometimes even with multiple professionals) over the course of months or even years, professionals may refer to the depression as “treatment resistant” or treatment-resistant depression (TRD). Treatment resistant depression is simply an episode of depression that resists typical treatments, such as psychotherapy or medications.

If treatment for your depression has not yet worked, don’t give up! Virtually all clinical depression is treatable, but it’s often a matter of finding the right type of treatment for each person. What this usually means is that it’s a matter of trial and error, working with a mental health professional to try different medications at different doses, or different types of psychotherapy strategies.

Traditional Treatments for Treatment Resistant Depression

Medications. Most antidepressants can take 6 to 8 weeks before a person will begin to feel their beneficial effects. This means that you may feel the side effects of the medication long before the clinical benefits of it. Hang in there, but if after 6 to 8 weeks, you still feel no less depression, it’s time to talk to your doctor again.

Doctors will typically try a strategy of increasing your dose, adding another medication, or changing your antidepressant medication altogether. Different doctors will implement different strategies. Research has shown that only 33 percent of people will respond to the initial medication they are prescribed. So hang in there, as you’re likely to be in that majority and need your doctor to look at adjusting your dose or medication.

In early 2009, Symbax (olanzapine and fluoxetine HCl capsules) was the first (and currently only) medication approved by the FDA for the acute treatment of treatment-resistant depression. Symbyax is a medication that combines long-acting Prozac with Zyprexa. Weight gain is one of the most common side effects of Symbyax.

Psychotherapy. Psychotherapy can also take time to work, although some people might feel the benefits of psychotherapy more immediately as it can work to address immediate life stressors or other problems.

Most psychotherapy for depression focuses on helping a person understand how their thoughts can impact their emotions and feelings of depression. It also seeks to help a person improve their interpersonal relationships and communication with others. If one form of psychotherapy seems unhelpful, you may need to work with your therapist on trying a different form.

Additional Strategies for Treatment Resistant Depression

There are many other strategies used to help someone who has treatment resistant depression. These should be considered when traditional treatments — such as trying multiple different types of antidepressants and more than one psychotherapist — have failed. Although no formal definition exists, typically a person is not considered to have treatment resistant depression (TRD) unless they’ve tried at least four different medications and at least one or two courses of psychotherapy.

Vagus nerve stimulation (VNS) is FDA-approved as an adjunctive long-term treatment of chronic or recurrent depression for patients 18 years of age or older who are experiencing a major depressive episode and have not had an adequate response to four or more adequate antidepressant treatments. It has shown to be effective in long-term clinical trials. In VNS, a device is put into the chest and sends an electrical current to the brain, which help reduce a person’s depressive feelings.

Electroconvulsive therapy (ECT) is another treatment option for treatment resistant depression. Despite its long history and negative reputation, ECT can be helpful for people whose depression is severe or life-threatening and for people who cannot take antidepressant medicine. In ECT, electrodes are placed on the head to deliver electrical impulses. A person typically undergoes a course of 8 to 12 sessions; most people need to continue such courses year after year, as the treatment usually wears off over time. The largest side effect of ECT is memory loss, the extent and degree of which cannot be accurately predicted by professionals.

Researchers are also looking at other neurostimulation treatments, such as transcranial magnetic stimulation (TMS), magnetic stimulation therapy (MST), and deep brain stimulation (DBS). Deep brain stimulation has been shown in clinical trials to help people with treatment resistant depression, but is not yet an FDA approved treatment for TRD.

Treatment resistant depression is often just another way of saying that a dedicated mental health professional hasn’t found an answer to a particular person’s depression. Even treatment resistant depression can be successfully treated, as long as both the person suffering from depression and his or her professional don’t give up hope.

 

APA Reference
Grohol, J. (2009). About Treatment Resistant Depression (TRD). Psych Central. Retrieved on November 23, 2014, from http://psychcentral.com/lib/about-treatment-resistant-depression-trd/0001676
Scientifically Reviewed
    Last reviewed: By John M. Grohol, Psy.D. on 30 Jan 2013
    Published on PsychCentral.com. All rights reserved.

 

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