DepressionDepression can be difficult to deal with, and treatment resistant depression can be even worse.

While depression can be a serious and debilitating mental illness that leaves people feeling like a shell of their former selves, it’s also extremely treatable, and with each passing year your outlook for recovering from depression only gets better! Antidepressant medications, therapy, and other treatment methods are more sophisticated than they’ve ever been, and you don’t have to resign yourself to feeling miserable when this mental illness rears its head.


However, there are people out there for whom many traditional treatments fail. While there’s no standardized definition for what constitutes treatment resistant depression, if you’re struggling to find a method, modality, or medication that works for you, you might fall into this category. Here’s what you need to know!

How is Treatment Resistant Depression Different?

These days, most people are familiar with the symptoms that qualify someone’s mental health struggles as standard clinical depression– persistent low mood, lack of enjoyment, feelings of worthlessness or hopelessness, and changes in daily habits like eating and sleeping are all included. Treatment resistant depression isn’t any different in terms of symptoms or presentation; instead, it’s identified by how the person responds to different ways of managing the disorder.


Different places and people have different benchmarks for what constitutes depression that is crossing over into being treatment resistant, but in order to classify, you have to have had multiple different treatments fail to produce an improvement in your symptoms– the rule of thumb is at least two different treatments. 

What Causes Treatment Resistant Depression?

If treatment resistant depression responds to drugs and therapy so much differently than non-treatment resistant depression, surely there must be a major mechanical difference between the two, right? Sadly this isn’t the case. For as much as scientists and doctors have made leaps and bounds in knowledge about mental health in the past few decades, there’s still a lot we don’t know. While we can identify common risk factors and potential causes for treatment resistant depression, no one knows exactly what the answer is, just like how no one knows exactly what causes depression in the first place. 


The answer is likely not a simple one, unfortunately. Depression itself is theorized to be caused by anything from chemical imbalances in the brain to environmental factors to genetic ones, and the same goes for treatment resistant depression. The reality is that most likely, all of these potential causes play a role in someone having depression, and in someone’s depression being resistant to treatment. It’s the same reason that some antidepressants work for certain people while others affect them negatively or produce no results– there’s probably a complex reason that has to do with the chemistry of their body, their life experiences, and their medical history and genetic makeup, but those reasons are nearly impossible to isolate and are most likely different from person to person.


This lack of knowledge can feel discouraging for someone who’s struggling to find relief from their depression, but don’t give up hope! There are still options out there that can help you to feel better, even if other treatments have failed for you.

How is Treatment Resistant Depression Managed?

Alternate Medications

If you’ve found that some of the most common antidepressant drugs in use today have not produced desirable results for you, there are many, many alternate medications that your doctor can help you with. Ketamine treatment might be beneficial for you, and so can lithium treatment. Switching to a different type of antidepressant might help, like tricyclic antidepressants or monoamine oxidase inhibitors as opposed to selective serotonin reuptake inhibitors. You might also try stacking different medications, adding on additional drugs to increase the effectiveness of one you’ve tried before, or trying medications for different disorders that have off-label uses for depression, like antipsychotic or anti-anxiety drugs.

Pharmacogenetic Testing

Different medications have different effects on different people, and sometimes your genes can play a role in how certain drugs like antidepressants function in your system. Looking into pharmacogenetic testing can be helpful in determining which medications will actually work for you if you’re struggling with treatment resistant depression. These tests can indicate which drugs, dosages, and combinations might be a good fit for you, eliminating some of the guesswork that can come with pharmaceutical treatment of a mental illness.

Transcranial Magnetic Stimulation

There are treatments out there for depression besides drugs and therapy, and transcranial magnetic stimulation is one of them. Not only is this an effective method of treating depression, it’s a very promising avenue for relieving treatment resistant depression that hasn’t responded to other methods. You can learn more about TMS and how it might be helpful for you on our website!