Treatment-Resistant Depression (TRD)

Dr. Saidi Depression, Treatment-Resistant Depression

Overview: What is Treatment-Resistant Depression?

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

Insomnia and Depression: 7 ways to treat Insomnia

Dr. Saidi Depression, Insomnia

insomnia-depression-treatmentIt is well known that depression can result in sleep problems. But can sleep problems cause depression? Although most of us realize that poor sleep can result in daytime fatigue and irritability, scientific studies have provided evidence that insomnia can cause clinical depression. So there appears to be a bidirectional association between the two: each increases the risk for the other, even when controlling for factors such as lifestyle, demographics, and anxiety level. This is why it is important to screen for and treat insomnia in those that show signs of depression. Early treatment of sleep problems may prevent or mitigate a depressive episode.

How do we treat sleep? There is a wide assortment of drugs available for treating insomnia which I will discuss in a later blog, but for now I will mention some of the simple steps we can take to treat insomnia on our own without medications.

7 Tips to Treat Insomnia

  1. Go to sleep and rise at about the same time every day, including weekends. The mind and body rely on and adapt well to this consistent cycle.
  2. Minimize stimulation. Keep the bedroom as dark as possible and minimize ambient noise (use earplugs if needed, turn off the TV or music).
  3. Use the bed only for sleep or sex.
  4. If you wake up in the middle of the night and can