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Treatment Resistant Depression

Treatment resistant depression is where the symptoms of depression do not fully improve following treatment or symptoms improve but keep returning.

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

This type of depression can be misdiagnosed, often with bipolar disorder or dysthymia / mild 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.

 

Can you cure treatment resistant depression?

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

To talk to someone today about the treatment options available call 0203 326 9160.

 

What causes treatment resistant depression?

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

 

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

 

Underlying health issues:

  • Other illnesses or issues can create depression including hypothyroidism, anaemia, heart problems, anxiety disorders, alcohol, substance abuse or other addictions.
  • Misdiagnosis. If the incorrect illness was being treated then no wonder it seemed 'resistant'. 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.

 

Improvement can be prevented by:

  • 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 lithium.

 

Psychotherapeutic approaches:

Psychotherapy – talking therapies have been found to help improve the symptoms of depression. A study from 19971 found that for more severe cases of treatment resistant depression, treatment was more successful where psychotherapy and medication were combined than these treatments alone.
Click to read more about talking therapies.

 

Other treatments (not currently provided by Clinical Partners) include:

ECT – electrical currents are passed through the brain to trigger a seizure. There can be side effects such as confusion or 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.

1 Michael, E., Thae, MD., Joel B. et al (1997) Treatment of major depression with psychotherapy or psychotherapy – pharmacotherapy combinations in Archive General Psychiatry 54(11): 1009 - 1015.

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