Psychiatric Diseases - Resistant Depression

How well is your depression treatment working? Does it help, but not enough -- and you still donít feel as well as you used to? Or is your depression treatment simply not working at all?

If so, you could have treatment-resistant depression, also called refractory depression. Unfortunately, depression treatments donít always work. As many as two-thirds of people with depression arenít helped by the first antidepressant they try. Up to a third donít respond to several attempts at treatment.

Treatment-resistant depression can leave you hopeless. Months or even years can go by without any relief. And after the effort it took to get help, it can be demoralizing when youíre just not getting better.

But if your depression treatment isnít working, donít give up. Many people can get their treatment-resistant depression under control. You and your doctor just need to find the right approach. This might include different drugs, therapy, and other treatments. If youíre still struggling with depression despite treatment, hereís what you need to know.

Understanding Treatment-Resistant Depression
What is treatment-resistant depression? Surprisingly, that can be hard to answer. Experts still disagree on what exactly the term means. Many say that itís a case of depression that doesnít respond to two different antidepressants from different classes. Other experts say that a person needs to try at least four different treatments before depression can be truly considered treatment-resistant. Of course for you, the exact definition doesnít matter. You just need to ask yourself some basic questions.

ē Has your treatment failed to make you feel better?
ē Has your treatment helped some, but you still donít feel like your old self?
ē Have the side effects of your medication been hard to handle?

If the answer is yes to any of these, you need to see your doctor. Whether or not you actually have treatment-resistant depression, you need expert help.

Treatment-Resistant Depression: Getting Help
Although a primary care doctor can treat depression (research suggests that 60-65% antidepressants are prescribed by primary care physicians), it may be best to see a specialist, like a psychiatrist, if you think you may have treatment-resistant depression. Itís a good idea to also work with a therapist, like a psychologist or social worker, because the best treatment is often a combination of medicine and therapy.

Treatment-resistant depression can be hard to diagnose. Sometimes, other conditions or problems can cause similar symptoms. So when you meet with your doctor, he or she will want to :
ē Confirm the diagnosis. Some people who apparently have treatment-resistant depression were misdiagnosed. They never had depression in the first place. Instead, they have conditions like bipolar disorder and have been getting the wrong treatment. Other people have dysthymia Ė a low-level, chronic depression Ė that is distinct from treatment-resistant depression.
ē Make sure youíve been using your medicine correctly. Up to half of all people who get prescribed drugs for depression donít take them as recommended. They miss doses or stop taking them because of side effects. Some give up too soon Ė it can take up to 12 weeks for a medicine to take effect.
ē Check for other causes. Other issues Ė ranging from thyroid problems to substance abuse Ė can worsen or cause depression. So can many medicines used to treat common medical problems. Sometimes, switching medicines or treating an underlying condition can resolve a hard-to-treat depression.

You may wonder why some people do so well with the first medication they try, while you continue to suffer. Experts donít really know. But evidence suggests that people who have especially severe depression may also be harder to treat. A long duration of symptoms may also increase the risk Ė which is one reason itís so crucial to get control of depression symptoms quickly. The longer depression goes on, the harder it may be to rule out other disorders that have similar symptoms to schizophrenia.

During an episode of schizophrenia, you may need to stay in the hospital for safety reasons.