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Treatment-resistant depression: Explore options when depression won't go away
Depression can resist your best efforts to treat it. Understand what causes this kind of chronic depression and what treatments are available, including new medication strategies or alternative treatments.
By Mayo Clinic staffMany people with depression get better with standard treatments — medications and psychotherapy — and return to enjoying a happy, fulfilling life. But there's a significant percentage of people for whom depression treatment just doesn't work, either fully or at all, and they continue to feel sad and hopeless, disinterested in activities, and perhaps even suicidal.
If you've been treated for depression but your symptoms haven't fully improved, you may have treatment-resistant depression, sometimes called chronic depression or resistant depression. Discuss your ongoing symptoms honestly and openly with your doctor or mental health provider. Also, use this FAQ to help explore reasons why depression treatment may not be working for you, and options you may want to consider.
What is treatment-resistant depression?
Treatment-resistant depression is generally defined as the continuation of depression symptoms despite treatment with at least three or four different medications. In other words, you and your doctor may have spent months or even years trying to find treatments that result in the remission of your depression symptoms, without success. This kind of chronic depression is not the same as dysthymia. Dysthymia is a less-severe form of depression, and although it's also long-lasting, its symptoms usually aren't disabling or life-altering.
What causes treatment-resistant depression?
Several factors may cause or contribute to treatment-resistant depression. These include:
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Depression severity. The more severe your depression initially is and the longer a depression episode lasts, the more likely the depression is to resist improvement with treatment and become chronic depression.
What to do: Carefully review your history of depression with your mental health provider. Knowing more about how long you've had depression and how severe it's been may help guide treatment.
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The wrong diagnosis. It's not always easy to diagnose depression and other mental disorders. In particular, some forms of bipolar disorder are commonly misdiagnosed as depression because manic phases may be less pronounced while depression phases are more pronounced — it may look more like depression.
What to do: Get a thorough reassessment of your condition. Find out if any close blood relatives have a history of bipolar disorder. Consider asking trusted family or friends to talk to your doctor — they can offer an impartial perspective on your symptoms.
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Other medical conditions. Other medical conditions or illnesses can sometimes mimic or worsen depression. These include thyroid disorders, chronic pain, anemia, heart problems, anxiety disorders, and substance abuse or addictions.
What to do: Ask about getting tested for other conditions or illnesses. Be honest about your use of alcohol or drugs. Consider asking your mental health provider and doctor to have a joint consult about your situation.
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Your social or life situation. If you're under constant stress or anxiety because of situations in your life that aren't getting better, medication alone might not help. These situations may include relationship trouble, financial instability or inadequate housing, for example. In addition, a childhood marked by severe adversity — such as abuse or neglect — can continue to affect you throughout adulthood.
What to do: Tell your mental health provider about your life situation, so that he or she knows what other issues you may be struggling with. If you haven't tried psychotherapy, give it a shot so that you can learn coping skills and stress management techniques.
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Your medication regimen. Many people, perhaps including you, don't strictly follow their medication regimen, which can reduce effectiveness. They may stop taking the medication, deliberately skip or lower doses, or forget to take a dose. Worse, they sometimes don't tell their doctor about this.
What to do: Don't lower your dose, skip doses or quit taking your medication without talking to your doctor first. And if you do so anyway, at least be honest with your doctor about your changes. If you tend to forget to take your medication, use a weekly pill box or other reminder system.
If you and your doctor or mental health provider pinpoint one of these factors as a possible source of your treatment-resistant depression, you can work together to develop a more effective treatment strategy.
What if there's not a clear cause for treatment-resistant depression?
It's not always known what factors cause or worsen treatment-resistant depression. You may not have gotten a wrong diagnosis or have other health problems, for instance. But don't give up on finding an effective treatment. Make sure you're being treated by the most appropriate health professional and then together, explore therapy and medication strategies you may not have tried yet, or consider some of the alternative or experimental depression treatments now available.
Who should treat treatment-resistant depression?
Depression can sometimes be treated by your family doctor, if you both feel comfortable with that. However, if your depression symptoms continue despite treatment, it's usually best to seek out a specialized mental health provider. In some cases, a psychiatrist and psychologist or other therapist can work together to make sure you're getting the appropriate combination of medications and therapy. You can also seek out a specialist in chronic depression.
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