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Treating Treatment Resistant Depression



At least 1/3 of the time depression doesn’t respond to the first medication tried.  If another attempt doesn’t work, it becomes “treatment resistant depression.”

If your depression isn’t lifting, here are ten ideas you might want to consider:

1) It might not be depression proper.  Bipolar depression – depression associated with the mood disorder Bipolar – does not respond like unipolar depression to antidepressants, and may instead require mood stabilizers.

One analysis says that up to one fourth of treatment resistant depression may be bipolar in nature.

2) Physical factors absolutely must be checked for, something that many doctors miss.  One study showed that perhaps half of people with depression have low levels of folic acid. Deficiency of Vitamin B12 is another common nutritional reason for depression.

A wide variety of digestive disorders may also cause depressive like symptoms or contribute to resistance to medications.  Evaluation of nutritional intake and very importantly how the body processes it is essential.

3) Thyroid problems often cause depressive like symptoms.  Even when treated, hypothyroidism can contribute to depression if the replacement hormones aren’t carefully chosen.  Adrenal problems are also very common along with conditions like hypoglycemia.

Treatment resistant depression is a strong reason to undergo testing for physiological issues that are implicated in depression.

4) Your depression may not go away if you still experience stressful life events and/or feel a lot of pressure.  Remember, depression can be a natural response to what’s going on in your life, and in that case, the only way to help it is by dealing with the root causes.

5) Switching medication is very common, especially considering how often initial treatments fail.  SSRIs are the first used medications, then alternative modern medications like SNRIs or DNRIs.  If those fail, tricylcic or MAO inhibitors are used.

It’s almost normal for your first try to not work.  Don’t give up or get discouraged.  Try different types of medication in different combinations.

It’s essential to have a doctor who understands the details of the antidepressants and give you proper guidance.

6) For very serious depression that doesn’t respond to treatment, electroconvulsive therapy might be worth considering. ECT, though it has side effects, may be the most effective treatment for depression with efficacy rates around 75%.

7) Lithium or other mood stabilizers alongside antidepressants might help.  They’ve shown excellent results in some studies – 45% response versus 11% for placebo. Patience is key; it takes 3-4 weeks and careful monitoring to achieve results.

8) Anti-psychotics also increase recovery rates, but they have significant side effects such as sedation, weight gain and possibly irreversible tics, so use is cautioned.

9) Stimulants like Ritalin and Adderall have shown mixed results. Theoretically, someone who is depressed and lacks energy might get a motivating kick from stimulants. In one study of 60 patients, 40% on Ritalin improved as opposed to 23% not, a statistically insignificant difference.

10) Don’t forget therapy.  An increasing amount of people just take antidepressants without seeing a therapist.  This means they miss the chance to work on the issues causing them to be depressed.

11) Extra point:  Exercise can help revitalize you.

Remember: Never give up

Never give up.  With the right combination of therapy, medication, exercise and dietary modification, things will improve.  Depression can rob you of the ability to see that there is hope.  There is a future, and you have the power to make it better, but you need to get the right help.

If you are experiencing suicidal thoughts right now, or do in the future, please consider getting immediate help. You can call 1-800-273-TALK or other hotlines to talk to someone right now.

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This post was written by on Sunday, August 9, 2009. This author has written 223 posts on this blog and has 5935228 total posts views.

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  1. Amazing! Not clear for me, how offen you updating your

    • Dear Joker,

      I try to update several times a week. But of course it depends on how busy I am, and how inspired (or more likely uninspired!) I am. Suggested topics are always welcome =)


  2. Thanks for your wanting to help people hopfully Karma is right.
    again thanks

  3. I found your blog on google and read a few of your other posts. I just added you to my Google News Reader. Keep up the good work. Look forward to reading more from you in the future.

  4. Intractable depression is exactly that. I’ve been depresssed and suicidal for decades. My first clear memories of being suicidal date back to when I was 12. I’m now 60 and been continuously on medication for 30 yrs. Depressive cycles have gone from 2 3-month depressions each year (mid-Jan to Easter & mid-Jul to late Oct) to multi-year episodes. Last one ran from May 2004 to Sept 2008 – and I’m now well into the next. The tough part is that folks do not understand that suicidal ideation has to be matched with the necessary personal strength, courage and determination to risk failure and ending very badly damaged physically and usually brain damaged as well. The result of course is that it can’t be discussed. Most folks want to live. It is very difficult to sit in support groups and empathises with with someone who desparately wantw to live, when permanent oblivion seems the best of all possible worlds.

    Ultimately, nothing works – at best one gains a bleak twilight.

    I do recommend lamotrigene as a mood stabiliser – it’s the only thing I know that blunts the acid edge of anguish in profound grief and despair.

    2250mg of lithium and later 1800mg valproate reduced me to a bearable (and obscenely obese) zombie mode – lamotrigine leaves you mentally clear.

  5. My first thoughts of suicide occurred when I was 9 or 10, I’m now 55. My depression doesn’t seem to cycle, it’s just one long continuous pain. I’ve tried about twenty-five drugs, alone or in combinations. There have been anti-depressants, anti-psychotics, stimulants, tranquilizers, mood stabilizers as well as drugs that I don’t know how to categorize. The best I can say about any of these drugs is that they have taken away my anger. This is no small thing, because it has saved my marriage and my relationships with my children. But I still feel like crap. Every day I want to die. I made an almost successful suicide attempt four years ago, but I promised my children I would not do it again. Now I hope for a terminal illness, because I believe that would nullify my promise to my children.
    As for ECT, I would not recommend it for anyone. There is no guarantee that it will help, but the side effects are forever. It has left me with severe cognitive impairment, which caused me to lose my job. So, not only do I feel worthless and depressed, I feel stupid and am poor as well.

    • I have been fighting depression since childhood, I am now 57 years old. I have tried every med out there, with little or no response including ect. The only thing that has kept me alive is an unfailing faith in GOD. I believe I suffer for a reason only known to HIM, and that one joyous day when I do die HE will let me know why I suffered so much. So please I beg all those out there with this terrible cross to consider going back to your faith and giving your suffering to the Almighty, He will give you strenght to perssevere till He calls you home. GOD bless you all.

  6. Just Another Guy

    It is also important to mention that these drugs are usually only tested for 8 weeks (2 months). For example, 6000 people might be involved in a 2 month study and they call this 1000 man years of testing. I beg to differ. These studies are not the same as using 1000 people for 1 year or 500 people for 2 years or even 2000 individuals for 6 months. This is why drugs later get pulled from the market or require “black box” label warnings about their risks. Current studies are much too short in length.

    It also explains why “poop out” of the medication doesn’t officially show up in drug studies or official documentation. Drugs generally only “stop working” after a couple of months of use. The scientific name is Tachyphylaxis and very common. Look it up on Wikipedia.

    Please don’t get me started of the ethics of “ghost writing” reports for journals, whereby pharmaceutical companies write a glowing article about their drug and pay a well known MD to put his/her name to it for publication.

    Did I mention our patent system that allows the companies to make almost insignificant modifications to a drug and obtain another 17 year patent?

    No, I’m not some disgruntled ex-pharma employee. I’m just someone who has battled depression for 45 years. I, and I’m sure many other people have a drawer full of old medicine that either didn’t work, had horrible side effects, caused an allergic reaction or “stopped working”. We should be pushing legislators for mandatory refunds on these drugs. I can’t think of another industry that doesn’t offer complete refunds if the product does not taste/perform as advertised/designed, etc.

    I believe that the pharmaceutical industry is ethically challenged.

  7. I have never since remember of myself have suicidal ideas! Never till just recently !! 2 yrs ago after a wild life in London and NYC and coming back home to my small country and town where lived before I was SUDDENLY diognosed with bipolar disorder. since than things have changed. First it was Ok. i took mood stabilizators but small dosage and felt just perfectly fine. My cravings for alcohol and cocaine deseased and i was drinking but not so excessively and saw a new Great perspective on life . I came back to London than eventually back — for some time i said as i have had work waiting for me there and after a argument with my father i was asked to come to hospital again. I went though just to speak but the doc said i should stay there i bit . Okey i didnt care so much anyway i needed a rest so I agreed! Now its 10 months past and i cant sort myself out . I feel like a completely zombie , brain washed with no perception for reallity, Its just a wonder!!! After two times of trying to commit suicide one almost fatal ,pure becouse i couldnt live like that anymore I was put on anti depressants. No change however, some days better but most lethargic, with no interest whatsoever, no motion — i used to excise a lot before diagnosed with this shit of bipolar disorder , no apetite for life , completely lost in space!!! I lost my finances , my profession and all, im soo desperate as never before! I like to try Wellbutrin if can find it in here , but anyway whats ur thoughts any practical solution for this state??? I ve tried everything , turning even back to drugs as help but instead of initiall feeling of pleasure when taking them now i wasnt feeling anything or even worse went into completely ” lost ” state , I have internationally spread bussiness that is suffering becouse of that , I stoped even and unbeliavably Im in a social case after all those money and luxury I have had with that so called bi polar disorder before treating it …thats my experience really

  8. Oh Margaret if you read this , i feel so much for you darling !!! I feel the same, every day I want to die and Im only 28 with a short but brilliant career behind me!! Even if i live i dont know how will i manage like this as my cognitive processes are completely ” attacked” from all that pills and treatments, I was so perfectly ok before being diagnosed with Bi- polar disorder, a bit f**ked up but i knew my faults and was correcting them instantly , I just feel so much with all those with depression , i have had it for now for first time — or first time i have had chance to feel it this was and damn is awful state!!! How do you guys keep your jobs and manage financicly in this state lolll for me thats a battle i still have to try i guess bbbb best for all

  9. What about personality disorders? Seems psychiatrists never investigate it because drugs don’t help the disorder. So they don’t care about the patient just there money and insist on prescribing drugs for anxiety and depression. Makes me worse and not want to get help just die.

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