Depression typically responds well to medication and therapy. However, some people find their symptoms persist even after trying multiple medications: this is called treatment-resistant depression or “difficult-to-treat” depression. Thankfully, innovative treatment options exist for people in this position.

Thankfully, treatment approaches like Spravato® for depression, transcranial magnetic stimulation (TMS), and other emerging options are providing new sources of relief for those with difficult-to-treat depression.

What Is Treatment-Resistant Depression?

Treatment-resistant depression is typically diagnosed when someone has tried two or more antidepressant medications without experiencing significant improvements in symptoms. This can be frustrating for both the person with TRD and their loved ones, as they may feel like there are no effective treatment options available to them.

Whether you have been diagnosed with TRD or are experiencing symptoms that do not seem to improve with traditional treatment, it is important to seek help from a mental health professional who specializes in evidence-based treatment for depression.

While your primary care provider is technically able to diagnose depression and provide a prescription for an antidepressant, they may not have the time, training, or dedicated resources to provide the appropriate amount of support for those with difficult-to-treat depression. A personalized treatment plan can significantly improve your chances of managing symptoms and finding relief.

How Common Is Treatment-Resistant Depression?

Studies estimate that about 30% of people diagnosed with depression meet the criteria for treatment-resistant depression, meaning that they’ve tried at least two medications without alleviation of depression symptoms.

However, research also notes that many of these cases might be “pseudo-resistant,” meaning that there was inadequacy of treatment or the person didn’t stick with their treatment plan. Again, this highlights the need to work with a mental health professional with training in evidence-based treatments for depression.

Signs & Symptoms of Treatment-Resistant Depression

The signs of TRD may be similar to those of other forms of depression, such as low mood, fatigue, and persistent feelings of hopelessness. However, these symptoms are more persistent and do not seem to resolve even after taking medication.

Signs of depression may include:

• Persistently low mood
• Loss of interest in activities once enjoyed
• Changes in appetite and sleep patterns
• Difficulty concentrating
• Feelings of hopelessness or worthlessness
• Physical symptoms like headaches, stomachaches, or chronic pain without a clear cause

If you have been experiencing these symptoms for an extended period of time, it may be a sign that traditional treatments are not effective for you and that you may have TRD.

Risk Factors for Treatment-Resistant Depression

The risk factors for developing TRD are not fully understood, but researchers believe it may be caused by a combination of genetic, environmental, and biological factors. Some studies have also shown that people with a history of trauma may be more likely to develop hard-to-treat depression.

Management of Treatment-Resistant Depression

For those with difficult-to-treat depression, traditional depression treatments like antidepressants and therapy may not be enough. That’s where emerging treatments like Spravato® and TMS therapy come in. Both Spravato® and TMS therapy have shown promising results for those with TRD, providing new hope for individuals who have not found relief with traditional treatments.

Despite their proven effectiveness, TMS and Spravato® are not always well known or available at many mental health clinics or doctors’ offices. If you’re in therapy and/or taking medication, it’s important to remain on your treatment plan, but it could also be time to reach out to find additional treatment at a specialized clinic.

Transcranial Magnetic Stimulation (TMS)

TMS therapy has been a trusted depression treatment for decades. It uses magnetic fields to stimulate specific areas of the brain that are thought to be involved in depression. This non-invasive treatment has been shown to have significant benefits for those with TRD, including improved mood and a reduction in symptoms.

One major benefit to TMS is that it usually involves very few side effects compared to many medications, so if you’ve had a bad reaction to multiple antidepressants, TMS could be a helpful alternative.

Esketamine for TRD

Spravato® is a nasal spray medication that has been approved by the FDA for the treatment of TRD. It contains esketamine, a type of ketamine, and works by targeting glutamate receptors in the brain. This can help improve mood and reduce symptoms of depression.

Changing or Adding Medication

If multiple antidepressants haven’t been able to alleviate symptoms, a psychiatric provider might change or add to your medication regimen. It’s important to talk to your care team about what’s working and what’s not so they can track your symptoms and change your dosage as necessary.

Does Therapy Still Help With Treatment-Resistant Depression?

Yes, therapy can still be helpful for hard-to-treat depression. One meta study found that cognitive behavioral therapy, dialectical behavioral therapy, interpersonal therapy, and short-term dynamic psychotherapy all contributed to an overall improvement in depressive symptoms for those with difficult-to-treat depression.

Adding TMS or Spravato® to your treatment plan can also make therapy more effective, and concurrent therapy is always recommended with either treatment. It’s important to stick with the treatment plan your care team suggests, as all the components can work together to help mitigate symptoms.

Other Steps You Can Take to Manage Treatment Resistant Depression

Depression can feel like it overtakes every aspect of your life, especially if you’ve been in treatment for a while and aren’t seeing relief. It’s important to talk with your care team about setting up a holistic plan for caring for yourself.

Here are more ways you can support yourself while dealing with treatment-resistant depression:

• Stick to your treatment plan: It can feel taxing to continue going to therapy and taking medication if you’re not feeling relief. However, change can often happen slowly, so sticking with treatment is paramount to gradually getting better. You could also ask your care team about what other innovative treatments you could be eligible for, like TMS or Spravato®.
• Avoid substance use: Substances like alcohol, nicotine, and cannabis can all interact negatively with medication and alter brain function in ways that can exacerbate depression symptoms over long-term use.
• Manage stress: Whatever you can do to make day-to-day tasks feel easier and take some of the load off your plate could help you feel lighter in general, and give more time to getting the treatment you deserve without feeling extra overwhelm.
• Get enough sleep: Sleep and mental health are inextricably linked, but depression can often make sleep difficult. Be sure to prioritize sleep hygiene and at least set aside time for sleep and rest, even if staying asleep isn’t possible.
• Move your body regularly: Regular activity boosts feel-good chemicals in the brain, and even a small amount of movement can help improve your mood.
• Build your social supports: Depression can often make you feel isolated. Combat this by reaching out to a couple of trusted loved ones and tell them how you’ve been feeling. See if they can check in on you from time to time so you feel less alone.

Call Northeast Health Services Today for Expert Depression Treatment Services

If you or a loved one are struggling with TRD, know that help is available. Northeast Health Services offers Spravato® and TMS therapy to our neighbors across Massachusetts who have difficult-to-treat depression and are looking for additional treatment options.

Our compassionate team of mental health professionals will work with you to create a personalized treatment plan that addresses your unique needs and goals. Don’t give up hope. Call 508.794.8711 or reach out online today to get started.