Depression is a highly treatable condition. But for many people, the path of treatment and recovery can be challenging.
What’s the definition of treatment-resistant depression?
The definition of treatment-resistant depression can vary. This is because the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) doesn’t include the condition for official clinical diagnosis.
Treatment-resistant depression typically describes people with major depressive disorder (MDD) who have tried at least two types of antidepressant medication but are yet to find relief from their symptoms. This is common, with up to two-thirds of people not responding to the first prescribed antidepressant medication.
Some experts may also define treatment-resistant depression as depression that continues to be present even after receiving first-line treatments, including medication and psychotherapy.
Co-occurring conditions, such as post-traumatic stress disorder (PTSD) or substance use disorder, may also make it more difficult to find an effective treatment for MDD.
This doesn’t mean that your depression symptoms will be resistant to all treatment types. It simply means that your depression symptoms have not responded to the treatments you have tried so far.
Reassuringly, around 40% to 60% of people with MDD find relief from their symptoms with medication.
Medications
If a medical professional says that you’re experiencing treatment-resistant depression, it likely means that you’ve already tried some form of antidepressant medication.
SSRIs and SNRIs
The most commonly prescribed antidepressants are called selective serotonin reuptake inhibitors, or SSRIs. Some common types of SSRIs include:
- fluoxetine (Prozac)
- sertraline (Zoloft)
- citalopram (Celexa)
- escitalopram (Lexapro)
- paroxetine (Paxil)
Some common serotonin-norepinephrine reuptake inhibitor (SNRIs) include:
- duloxetine (Cymbalta)
- desvenlafaxine (Pristiq)
Often, it takes a journey of trial and error to find the exact medication and dosage that works for you, so you and your doctor may need to discuss trying more than one or two SSRIs or SNRIs.
It’s important not to suddenly stop taking SSRIs, as this can cause unwanted discontinuation or withdrawal symptoms, including dizziness, nausea, and “electric shock” sensations. For this reason, it is important to always follow your doctor’s advice when stopping any medication.
Other antidepressants
If SSRIs and SNRIs haven’t been effective for you, other types of medications may include:
- norepinephrine and dopamine reuptake inhibitors (NDRIs), like bupropion (Wellbutrin)
- tricyclic antidepressants (TCAs), like imipramine (Tofranil)
- serotonin antagonists and reuptake inhibitors (SARIs), like trazodone (Molipaxin)
- monoamine oxidase inhibitors (MAOIs), like phenelzine (Nardil)
- noradrenaline and specific serotonergic antidepressants (NASSAs), like mirtazapine (Remeron)
Doctors and healthcare professionals may not always consider these medications for initial depression treatment due to their side effects, which can include:
- drowsiness
- insomnia
- weight gain
- constipation
- increased heart rate
- sweating
It is important to always follow the advice of your professional healthcare team.
Adjunctive medication
Doctors may sometimes treat treatment-resistant depression with a combination of antidepressant medications and another class of psychiatric medication, like an antipsychotic or mood stabilizer.
These can include lithium (Lithobid), which may especially apply if you live with bipolar depression, or a second-generation antipsychotic like aripiprazole (Abilify) or quetiapine (Seroquel).
If you need help covering the cost of medications, the free Optum Perks Discount Card could help you save up to 80% on prescription drugs. Follow the links on drug names for savings on that medication, or search for a specific drug here.
