Treatment-Resistant Depression

Everyone gets down from time to time, but feelings of sadness that last two or more weeks may be a sign of clinical depression. It is a real and serious health condition that affects more than 20 million American adults each year.[1]
These are signs and symptoms of depression:
- Persistent sad, anxious, or empty mood
- Feelings of hopelessness or pessimism
- Feelings of guilt, worthlessness, or helplessness
- Loss of pleasure or interest in once-enjoyable activities, including sex
- Little or no appetite and weight loss, or overeating and weight gain
- Restlessness and/or irritability
- Difficulty concentrating, remembering things, or making decisions
- Loss of energy, fatigue, or being “slowed down”
- Insomnia, early-morning awakening, or oversleeping.
Can depression be treated?
Depression is highly treatable with treatments such as therapy, medicine, and lifestyle changes. But it may not always be easily treated. For many people, depression may continue despite treatment. They may have treatment-resistant depression or TRD. This happens when medicine partly relieves their symptoms or does not help at all.
How is TRD treated?
If treatment hasn’t yet worked for you, do not give up! Try to stay hopeful that you will get well and even recover. Consider these options and talk to your doctor about which treatments may be right for you.
- Medicine. Medicine can ease depression symptoms. But the first medicine you take may not be the right one for you. If you still have symptoms after initial antidepressant treatment, you should not give up. It may take some time for the medicine to start working, or it might help to change the amount you take. Or you may need to try several different medicines, take more than one medicine, or add other forms of treatment, such as psychotherapy. Keep in mind that finding the right medicine(s), or combination of treatments for TRD, can take some time.
- Psychotherapy. A trained mental health professional helps you talk about your moods and behaviors. Therapy can offer you new ways to manage stress and avoid negative events that can set off depressive symptoms.
- Support Groups. Talking with other people who also have depression may help you feel less alone and more informed about your illness and treatments. There are many local support groups for people with depression.
- Neurostimulation. Neurostimulation is becoming an option for people who have tried a variety of antidepressants, but they didn’t work, only partly worked, or stopped working.
Vagus Nerve Stimulation (VNS) is one type of neurostimulation that has been approved as an additional treatment for long-term or recurrent depression in adults who have not had success with four or more antidepressant medicines. A device is put into the chest and sends an electrical current to the brain.
Electroconvulsive Therapy (ECT) is another type of neurostimulation. ECT can be helpful for people whose depression is severe or life-threatening and for people who cannot take antidepressant medicine.[2] Electrodes are placed on the head to deliver electrical impulses. ECT has been controversial, but has improved in recent years. It can help when antidepressant medicines do not work well enough. Researchers are also looking at other neurostimulation treatments, such as transcranial magnetic stimulation (TMS), magnetic stimulation therapy (MST), and deep brain stimulation (DBS).
Research Update
Researchers at the National Institute of Mental Health, part of the National Institutes of Health, are looking at the effectiveness of different treatments for people who still have symptoms from depression after they have already tried an antidepressant. The study has multiple phases. So far, they have released these results:
- One in three people were symptom-free with the first medicine they used.[3]
- One in three people became symptom-free with the help of an additional medicine.[4]
- One in four people became symptom-free after switching to a different medicine.[5]
- For those people who tried switching to a second medicine and still had symptoms, one in five of them then became symptom-free when they switched medicines again.[6]
The study shows that people who have tried antidepressants, but still have symptoms from depression, have a variety of medication options.
Tracy’s Story
For many weeks, I felt tired but couldn’t sleep. I didn’t feel like eating and felt sad all of the time. I stopped seeing friends and felt hopeless about my life. I knew something was wrong and talked to my doctor, who gave me a prescription for an antidepressant and suggested counseling. I started taking medicine and was in counseling, but after four months, I still didn’t feel a lot better. But I continued to work with my doctors, and as a team, we found a medicine that helped me. Gradually, I began to feel better. It was a long process, but with help, I was able to get through it.
Remember
- If treatment doesn’t work right away, don’t give up.
- You may need to change the amount of medicine you take, take more than one medicine or switch medicines, or try more than one treatment.
- If you’re taking medicine, don’t stop taking it on your own. Talk to you doctor first.
- Work closely with your doctor to find the best treatment for you.
This information is being provided through an educational (unrestricted) grant from Cyberonics, Inc.
[1] Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun; 62 (6): 617-27.
[2] Frank E, Karp JF, Rush AJ (1993). Efficacy of treatments for major depression. Psychopharmacology Bulletin, 1993; 29:457-75.
[3] National Institute of Mental Health
[4] National Institute of Mental Health
[5] National Institute of Mental Health
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Support Groups for Depression
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BRIDGES is a peer-to-peer support group led by a trained facilitator, designed to serve adults who have a mental health diagnosis. Although some participants might have substance use issues as well, this support group is not solely focused on substance use.
AT THIS TIME, due to COVID, all groups meet virtually via Zoom; no Zoom account needed to join the meeting. Persons who are interested in participating should send an email (see address below) to request an invitation link. If you have general questions before requesting an invitation link, call the number listed below and leave a message for Ramona Taylor, the BRIDGES Director. MHA is working remotely, so please allow a day or two for your call to be returned.
No charge to participate.
Mental Health America of Eastern Missouri
1905 S. Grand Blvd.
St. Louis, MO 63104
Contact Information:
Ramona Taylor
314-773-1399
bridges@mha-em.org
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Virtual Meetings schedule
Mondays, 6:30 - 8:30
Thursdays, 6:30 - 8:30
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This group provides support for family and friends of individuals with mental illness.
St. Joseph's Hospital/Breese
9515 Holy Cross Lane
Breese, IL 62230
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618-882-3306
sharon206@prodigy.net
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Meets: 2nd and 4th Mondays, 7:00 p.m.
Location: Breese-Mater Dei Library, 900 Mater Dei Drive, Breese, IL 62230
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City Hope Bible Church
5868 West Florissant Avenue
St. Louis, MO 63120
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Phyllis
314-385-9129
314-383-7771 church
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Depression Bipolar Support Alliance
907 Dock St
St Louis, MO 63147
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Helen or Sarah
314-652-6100
866-525-1442 Friendship Line
hminth@sbcglobal.net
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Emotions Anonymous International Headquarters
P.O. Box 4245
St. Paul, MN 55104
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651-647-9712
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Karla Smith Foundation
14 Park Place Suite B
Belleville, IL 62226
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618-624-5771
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NAMI St. Louis
1810 Craig Road #124
St. Louis, MO 63146
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HELP Line
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800-950-NAMI
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A Christian support group committed to ministering to the spiritual, emotional, and physical needs of individuals and families affected by mental illness. Within an atmosphere of acceptance, compassion, and empathy we offer relevant information, and trustworthy resources related to issues commonly associated with and experienced by those who have a loved one affected by a neurological disorder or a chemical imbalance. We provide a place to share one’s faith in God and one’s personal experiences as we walk a similar path alongside a family member, friend, or loved one living with a serious mental illness.
Central Presbyterian Church
7700 Davis Drive
St. Louis, MO 63105
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Pat Grace
grace1pat@sbcglobal.net
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Recovery, International
Contact Information:
312-337-5661
866-221-0302
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Email Chuck at johnbeerg13@gmail.com for info about group meetings in St. Louis, Union and Ste. Genevieve, MO.
Visit recoveryinternational.org/meetings/find-a-meeting to locate groups and coordinators anywhere in the country.
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CenterPointe Hospital
4801 Weldon Spring Pkwy
St Charles, MO 63304
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Gregg Sansone
636-236-2267
greggsansone@hotmail.com