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Who this page is for
This page is for adults who have tried two or more treatments for depression and still do not feel like themselves, and for the people who care about them.
It is not for emergencies. If you are thinking about ending your life, call or text 988 now. If you are in danger, call 911.
What it means, in plain words
Most treatments for depression help many people. But no single treatment helps everyone. When depression has not improved after at least two different treatments, each given at a good dose for long enough, clinicians often call it treatment-resistant depression.
The name can sound final. It is not. It describes where treatment has been, not where it can go. Large studies have found that many people need more than one or two treatment steps before they feel well.
How we think about it
When treatment has not worked, we do not assume the person is the problem. We assume our picture is incomplete. So we go back over the story before we change course.
What we check first
- Was each treatment given a fair trial? Many medicines need 6 to 8 weeks at a good dose. A trial that was too short, too low, or stopped because of side effects tells us something different.
- Is it really only depression? Bipolar spectrum, ADHD, trauma, anxiety and substance use can all look like depression that will not lift. They can change which treatments make sense.
- What is the body doing? Thyroid problems, sleep apnea, chronic pain, hormone changes and some medicines can keep depression going.
- What is life doing? Ongoing stress, grief, loneliness or an unsafe situation can keep anyone down. Medication cannot fix those, but a plan can take them into account.
Options we may discuss
- Changing the dose, or switching to a different medicine.
- Adding a second medicine that can boost the first.
- Psychotherapy, alone or alongside medication.
- Better sleep, movement and less alcohol, which help more than people expect.
- Treatments given in specialized programs, such as ECT (electroconvulsive therapy) or esketamine nasal spray. We do not provide these, but we can help you decide whether they fit and find a program.
TMS: coming soon
TMS (transcranial magnetic stimulation) uses magnetic pulses to stimulate a part of the brain involved in mood. It is FDA-cleared for depression that has not improved with medication. It does not need anesthesia, and you can go about your day afterward.
We do not offer TMS yet. We plan to offer it at Olida offices. We will update this page when it is ready.
Questions to bring to your clinician
- Have my past medicines been given at a full dose for long enough?
- Could something besides depression be part of the picture?
- Should any blood tests or a sleep study be done?
- What are my options if this next step does not work?
- How will we measure whether I am getting better?
- Is TMS, ECT or esketamine worth discussing for me?
What this page is not
This page is general education, not medical advice for you. It cannot tell you what to take or stop. Please do not change or stop a medicine without talking to the clinician who prescribed it.
Sources
- Gaynes BN, et al. Defining treatment-resistant depression. Depression and Anxiety, 2020.
- McIntyre RS, et al. Treatment-resistant depression: definition, prevalence, detection, management, and investigational interventions. World Psychiatry, 2023.
- Rush AJ, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. American Journal of Psychiatry, 2006.