Mayo Clinic Health Manager

Get free personalized health guidance for you and your family.

Get Started

Free

E-Newsletter

Subscribe to receive the latest updates on health topics. About our newsletters

  • Housecall
  • Alzheimer's caregiving
  • Living with cancer

Treatment-resistant depression: Explore options when depression doesn't get better

Sometimes depression doesn't get better, even with treatment. Explore why this sometimes happens and what you can do about it.

By Mayo Clinic staff

If you've been treated for depression but your symptoms haven't fully improved, you may have treatment-resistant depression. Medications and psychotherapy work for most people. But with treatment-resistant depression, standard treatments don't help much or don't help at all. With treatment-resistant depression, symptoms — such as feeling sad, hopeless and disinterested in activities — persist despite treatment. Or, your symptoms improve only to keep coming back. Treatment-resistant depression can range from mild to severe, and generally requires trying a number of treatments to find out what works.

Use this guide to explore reasons why your depression treatment may not be working and options you might want to consider.

What causes treatment-resistant depression?

Like other types of depression, treatment-resistant depression is most likely caused by a combination of inherited and environmental factors that affect brain chemicals called neurotransmitters. A number of things can contribute to treatment-resistant depression, including:

  • Emotional stress. If you're feeling stress or anxiety because of situations in your life that aren't getting better, medications alone might not help. Examples include relationship issues, financial problems or inadequate housing. In addition, childhood abuse or neglect can continue to affect you throughout adulthood. Psychotherapy can be especially helpful in coping with stressful situations.
  • Not taking medications exactly as prescribed. Treatment may not work if you stop taking your medication, skip or lower a dose, or forget to take a dose. Many people get off track. This can happen for a number of reasons, including problems with side effects, thinking you don't need medication or that you don't need a full dose of medication because you feel better, or simply forgetting. If you do stop taking your medication, forget to take a dose or make other changes, be honest with your doctor about it so that you can address any problems and get back on track.
  • Underlying health problems. 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 addiction.
  • Another mental health diagnosis. It's not always easy to diagnose depression, and other mental health disorders may require different treatment. In particular, some forms of bipolar disorder are commonly misdiagnosed as depression if manic phases are mild. In many cases, depression occurs along with other conditions — such as panic disorder or post-traumatic stress disorder — which can make depression more difficult to treat. Ask your mental health provider whether your symptoms may be caused by bipolar disorder or linked to another mental health condition.

If you and your doctor or mental health provider pinpoint one of these factors as a possible source of your depression, you can work together to develop a more effective treatment strategy. It may never be clear what causes or worsen your depression, but you're still likely to find treatment that helps through a trial-and-error approach.

Who should treat treatment-resistant depression?

Your family doctor can prescribe antidepressants and give you advice. But if your depression symptoms continue despite treatment, you should see a medical doctor who specializes in mental health (psychiatrist). You may also need to see a psychologist or other mental health counselor. It can be helpful if all of the mental health providers involved in your treatment communicate and work together.

What is the goal for treating depression?

Even though you may find a treatment that's somewhat effective at relieving your symptoms, keep trying to find the best treatment possible. People who find treatment that completely relieves symptoms are less likely to have a relapse of their depression later. That's why it's important to be patient and not settle for a treatment that isn't fully effective. Also, keep trying different treatments if your current treatment causes significant side effects.

Next page
(1 of 2)
References
  1. Katon W, et al. Treatment of resistant depression in adults. http://www.uptodate.com/home/index.html. Accessed July 17, 2009.
  2. Matthew SJ. Treatment-resistant depression: Recent developments and future directions. Depression and Anxiety. 2008;25:989.
  3. Carvalho AF. Augmentation strategies for treatment-resistant depression. Current Opinion in Psychiatry. 2008;22:7.
  4. Stahl SM. Novel therapeutics for depression: L-methylfolate as a trimonoamine modulator and antidepressant-augmenting agent. CNS Spectrums. 2007;12:739.

DN00016

Aug. 27, 2009

© 1998-2010 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.com," "EmbodyHealth," "Enhance your life," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research.

Print Share Reprints

Text Size: smaller largerlarger