If a person with major depressive disorder (MDD) has not responded to at least two types of medication, they have treatment-resistant depression.
This means that they have not experienced adequate relief from their symptoms after trying
Although treatment-resistant depression can be difficult to manage, doctors have a variety of interventions to treat it. One choice involves changing from a first-line medication to an older antidepressant drug.
Alternatively, a healthcare professional may add a non-antidepressant drug to a person’s medication regimen. They may also recommend psychotherapy, brain stimulation, or new drugs.
Read more to learn about treatment-resistant depression, how doctors manage it, and more.
Doctors classify cases of MDD as treatment-resistant depression when two antidepressants from two different drug classes do not relieve a person’s symptoms.
According to a 2021 study published in the Journal of Clinical Psychiatry, 30.9% of people in the United States who take medication for their MDD have treatment-resistant depression.
MDD, also called clinical depression, can
- feelings of worthlessness and hopelessness
- low energy and motivation
- irritability and confusion
- poor sleep, appetite, and sex drive
Older
- Not staying on medication long enough. It can take 6–8 weeks for a drug to work properly, so if a person stops too early, their symptoms may not improve.
- Drug interactions. Some medications interact adversely or dangerously with antidepressants.
- Skipping doses. An person must take antidepressants according to the directions in order for them to work properly. For most medications, this means taking the drug daily.
- Genetic disorder. There is a genetic condition that prevents the synthesis of a substance the body needs to make serotonin.
- Alcohol or drug misuse disorders. These conditions can inhibit depression treatment.
- Co-occurring medical or psychiatric conditions. These conditions need treatment at the same time that a person receives treatment for depression.
- Wrong diagnosis. It is possible that someone has a condition other than treatment-resistant depression.
- Poor compliance. Environmental factors, such as a busy schedule or financial challenges, can affect treatment compliance.
- poor quality of life
- functional impairment
- self-harming behavior
- high relapse rate
- suicidal ideation
Suicide prevention
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.
According to
However, a few studies suggest electroconvulsive therapy produces a higher rate of remission.
One of these is an older
According to a 2020 study, experts do not fully understand how remission works. They still have much to learn about helping people reach and maintain remission.
A diagnosis of treatment-resistant depression means a person has tried two different antidepressants that did not provide sufficient symptom reduction. About one-third of people with MDD have treatment-resistant depression.
A doctor may recommend adding or changing medications, psychotherapy, electroconvulsive therapy, or new or novel medications.