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Ask the Doctor: Treatment-Resistant Depression

By Ken Duckworth, M.D., NAMI Medical Director


It is frustrating for all involved when someone does not respond to treatments for depression that work for most other people. But we can’t accurately predict who will respond to a particular intervention, and some will be in the group called the “non-responders.” Calling them “non-responders” almost sounds like we are blaming them for not getting better, doesn’t it? Let’s not blame these people, but rather review some strategies to address treatment-resistant depression and discuss a novel treatment has come down the pike.

When clinical (or major) depression, about 20 percent to 30 percent of people do not respond to treatment. We don’t know why; this is just the state of the field right now. The first thing I encourage people to do when they have not responded to treatment is to review the basics of their care, aside from medications. The foundations of self-care – aerobic exercise, eliminating toxic stressors, building supportive relationships, getting enough rest, and a healthy diet – are essential. If your thoughts are persistently negative, give cognitive behavioral therapy (CBT) a good trial in addition to your medicines. If there is not a CBT practitioner in your area, Feeling Good: The New Mood Therapy, by David Burns, M.D., is a classic guide with easy-to-read descriptions of CBT. Most studies show that combining talk therapy like CBT together with medications produces a better result than either treatment alone.

If your depression persists, think about other possible causes – could you have a medical problem like hypothyroidism that could explain it? This condition can be detected with a simple blood test. Could other medications you take be contributing to your depression? This is a common problem with beta blockers for high blood pressure, and also with some treatments for Parkinson’s disease. Alcohol can also complicate a depression picture, so attention to sobriety can be crucial.

There are also many subtypes of depression. For example, people with bipolar depression often have atypical symptoms – such as sleeping more and eating more – and this is a challenge to treat. Seasonal depression in winter can add to the picture, and light therapy can be helpful for that. Depression with psychotic features typically responds very well to electroconvulsive therapy, or ECT, also known as shock therapy.

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