Treatment-Resistant Depression does not mean that your depression is inherently worse or more difficult to treat — just that you haven’t found the right medication yet.
What is treatment-resistant depression?
Treatment-Resistant Depression (TRD) is a diagnosis that can be broken down into 3 key criteria. This diagnosis is not in the Diagnostic and Statistical Manual of Mental Disorders, or DSM, that is the source of many diagnostic codes. This is a clinical diagnosis given by mental health professionals based on a patient’s symptoms and medical history.
In order for a patient to qualify for TRD, they must meet the following criteria:
- Major Depressive Disorder (MDD) that has not responded adequately to at least two adequate trials of antidepressants from different classes
- Each trial of antidepressants was given at a therapeutic dose and taken consistently
- Each trial of antidepressants was taken for an adequate duration (typically meaning 6-8 weeks)
Who actually qualifies?
While these criteria may look simple, many patients end up with a diagnosis of treatment-resistant depression without fully meeting the qualifications.
There are several different classes of antidepressant medications. If a patient tries, for example, a trial of Prozac and then a trial of Paxil, this will not count toward a TRD diagnosis as both of these medications are classified as SSRIs. You need to have tried not only one (or multiple) medications that are classified as an SSRI, but also separately try a SNRI, or Atypical, or MAOI, or other class of antidepressant — each for 6-8 weeks at a therapeutic dose.
When you start on a new medication, it is common to start with a lower dose so that you can see how you do with that medication without a lot of side effects. From here, your dose may be ramped up to what is considered at therapeutic dose — but the initial time you spent using the medication at a lower, non-therapeutic dose also does not count toward a TRD diagnosis.
Patients may have tried many different medications, but within the same class of antidepressants, or at too low of a dose, or for too short a duration of time to qualify as ‘treatment-resistant’.
How a diagnosis impacts patients
For patients who receive a diagnosis of treatment-resistant depression, whether they fully meet the qualifications or not, it can feel very disheartening. Patients often feel that this diagnosis means that they are broken, or that their depression is uniquely more challenging than other kinds of depression and more difficult to treat. This can make it difficult to believe that any treatment will ever work for them.
To these patients, we ask you to keep a few things in mind.
To start with, for the most commonly diagnosed antidepressants — they are only effective for about 30% of patients on average. Failing to respond to one medication, or even multiple, is not an indicator that your depression is inherently worse or more difficult to treat when 2/3 of patients also don’t respond to that medication.
It can also be difficult to determine when an antidepressant is working, as the side effects may be so troublesome that you are switched to a different medication and stop the treatment course early, without knowing whether that medication would have been effective for you.
We encourage patients to remember that their TRD diagnosis does not mean that their depression is worse than other depressions, just that we haven’t found the correct medication for them yet.
We see patients who have tried many different medications, different classes of medications or adjunct medications, who have already tried ECT, or TMS, and several forms of therapy over the course of months or years. Often, it’s just a matter of finding the correct treatment, or series of treatments, or holistic grouping of treatments that can be really helpful in alleviating this episode of depression. While the obvious treatments may not have worked — there are still great solutions out there.
One possible answer
Ketamine treatment has been studied extensively and found to be effective in 70-80% of patients with treatment-resistant depression. For many of our patients, ketamine — in conjunction with other mental health strategies and holistic lifestyle changes — has been the answer to finally finding relief from their depression or other mental health conditions.
And to patients with a diagnosis of treatment-resistant depression for whom ketamine is not the answer, we highly encourage you to continue searching and have hope that there are things that will alleviate your depression.
References
Farrokh Alemi, Hua Min, Melanie Yousefi, Laura K Becker, Christopher A Hane, Vijay S Nori, Janusz Wojtusiak. Effectiveness of common antidepressants: a post market release study, eClinicalMedicine, Volume 41, 2021, 101171, ISSN 2589-5370, https://doi.org/10.1016/j.eclinm.2021.101171.
About Us
Wells Medicine is a Houston-based practice designed to provide meaningful care for mental health. Providing targeted interventional treatments for Depression, Anxiety, OCD, PTSD and other conditions, with Ketamine Treatments, Stellate Ganglion Blocks, TMS, and Nitrous-Oxide Treatments. Focused on comprehensive care and integration with Psychiatry, Psychology, and Support Services. We are evidence-based, patient-focused and mission-driven.
The content here is for informational purposes and should not be relied upon for medical decisions. For the details of your specific medical conditions and treatments consult your doctors or other qualified healthcare professionals.
