Overview: What is Treatment-Resistant Depression?
About one-third of people with major depression will respond to the first prescription antidepressant. In the remainder of cases, depressive symptoms may continue despite treatment, and is referred to as treatment-resistant depression (TRD). A person is labeled to have TRD when the symptoms fail to respond to at least two trials with separate classes of antidepressants.
How is TRD treated?
The flip side with TRD is that it can be misdiagnosed when instead there was simply a problem with either medication compliance or appropriate dosing. (1)
The initial steps are, therefore, to confirm or rule out TRD are:
1. Assess compliance with medication
You and your doctor should review the manner in which you are taking the medicine. Are you taking it every day (if so prescribed)? Should you be taking it with meals? Are you taking any other medications, supplements, or substances (e.g. alcohol) that can significantly interact with the absorption and metabolism of your medication?
2. Maximize the current antidepressant dose
Another factor that may lead to a false TRD label is that your doctor may not have tried the antidepressants at their maximum recommended doses and/or for the maximum duration. Hence, the next step will be to check and increase the dose of the antidepressant if required.
3. Check for any other illness
There is also a possibility that you have some other unaddressed medical or psychiatric illness that may be making the depression more resistant to treatment.
Next Steps for TRD
After confirming that you have TRD, your doctor may have to do a few trials to find the therapy that best