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What is Treatment-Resistant Depression?

Take-Away Points:

  • Treatment-resistant depression is depression which does not respond to multiple treatments (usually different types of antidepressants).
  • Treatment-resistant depression is quite common.
  • Cognitive-behavioral therapy (CBT) can be effective for treatment-resistant depression.
  • Treating any co-occurring insomnia may also lead to a lessening of depression.

Treatment-resistant depression, referred to as “refractory depression” by doctors, is depression which does not respond to multiple kinds of treatments. Just how many treatments that must be in order to be considered treatment resistant varies from doctor to doctor. Typically, a depression is said to be treatment-resistant, or refractory, when two to four different anti-depressants have little or no beneficial effect on it. Sometimes, a person may find that they do respond to an anti-depressant and their depression lessens—but the relief is only short-lived and the depression returns to its original severity in only a few short weeks. This may happen with each anti-depressant which is tried, as well.

Unfortunately, treatment-resistant depression is quite common. According to WebMD, up to 67% of people do not get relief by the first anti-depressant they try. This research paper reported that 40 to 50% of people who are first treated with antidepressants or ECT (electroconvulsive therapy) fail to experience “a timely remission” (effectively, a cure to the depression). That is a huge number of people left carrying that 1-ton boulder of depression on their shoulders when treatment fails to help.

Although treatment-resistant depression is most commonly thought of in terms of medical treatments such as antidepressants or electroconvulsive therapy, depression may also fail to respond to some kinds of psychotherapy. One form of therapy which is very successful in helping people to lessen their depression is called cognitive-behavioral therapy (abbreviated as CBT). The kind of therapy that I utilize with my clients has been described as “CBT on steroids.” This is a kind of enhanced CBT called TEAM CBT. If you would like to learn more about TEAM CBT, visit here.

One often overlooked area of treatment for people suffering from treatment-resistant depression is treating any co-occurring insomnia. Insomnia by itself can make a person much more likely to develop major depression and the reverse is also true: having depression makes insomnia more likely to develop. There is a clear link between quality and quantity of sleep and mental health. And treating insomnia alone has been shown to lead to significant improvements in depression in many cases. If you have treatment-resistant depression and insomnia, you may find that you can decrease the severity of your depression and help the effectiveness of your other treatments for depression by treating the insomnia at the same time. I offer a very effective drug-free treatment for insomnia called cognitive-behavioral therapy for insomnia. You can learn more about it here.

I think it is important for people who have depression or who love someone who has depression not to give up hope if someone suggests they might have treatment-resistant or refractory depression. The word is “resistant,” not immune. I have seen treatment-resistant depression respond impressively to cognitive-behavioral therapy after failing to respond to a dozen medications.

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