If you've been treated for depression but your symptoms haven't improved, you may have treatment-resistant depression. Taking an antidepressant or going to psychological counseling (psychotherapy) eases depression symptoms for most people. But with treatment-resistant depression, standard treatments aren't enough. They may not help much at all, or your symptoms may improve, only to keep coming back.
If your primary care doctor prescribed antidepressants and your depression symptoms continue despite treatment, ask your doctor if he or she can recommend a health care provider who specializes in diagnosing and treating mental health conditions.
The psychiatrist reviews your medical history and may: ask about life situations that might be contributing to your depression; consider your response to treatment, including medications, psychotherapy or other treatments you've tried; review all of the medications you're taking, including nonprescription drugs and herbal supplements; discuss whether you are adhering to your treatment plan and taking your medications as directed; consider physical health conditions that can sometimes cause or worsen depression, such as thyroid disorders, chronic pain or heart problems; and consider a diagnosis of another mental health condition, such as bipolar disorder, which can cause or worsen depression and may require different treatment — or dysthymia, a mild but long-term (chronic) form of depression — or a personality disorder that contributes to the depression not getting better.
Treatment-resistant depression symptoms can range from mild to severe and may require trying a number of approaches to identify what helps.
Depression Treatment Isn't One-Size-Fits-All
Treatment can work on different pathways in the brain.
SSRIs: a first step for many.
When you were first diagnosed with depression, you were likely prescribed a selective serotonin reuptake inhibitor (SSRI) — a medication that increases serotonin, a brain chemical linked to mood. Depression is often described as a chemical imbalance in the brain, and SSRIs are believed to rebalance brain chemistry by raising serotonin levels.
But wait, depression doesn't impact only one type of brain chemical.
If SSRIs aren't working well enough for you, healthcare providers may switch to or add treatments that target other brain chemicals, such as serotonin-norepinephrine reuptake inhibitors (SNRIs) or norepinephrine-dopamine reuptake inhibitors (NDRIs). These affect the brain chemicals norepinephrine and dopamine. Many people see some improvement. But if you still feel your depression could be better managed, it's not just in your head. It may mean your depression requires a different approach.
Meet other chemical messengers in the brain.
While some medications focus on serotonin, norepinephrine, or dopamine, the brain also uses other chemical messengers that help regulate mood — like glutamate and GABA. Glutamate is believed to help regulate mood, and is involved in about 90% of brain connections. GABA is another chemical messenger that may help calm brain activity and support balance in mood. For some people, treatments that work differently may offer another option.