You’ve followed your doctor’s treatment protocol for depression and even changed medication, but nothing seems to help, or help for very long. It’s a frustrating predicament, one that may lead you to give up hope you will ever find relief.
Know that you are not alone. Treatment-resistant depression (TRD) affects about one-third of patients diagnosed with major depressive disorder, according to the National Institutes of Health. This diagnosis is typically made after a patient has tried 12 sessions of psychotherapy and at least two trials of medications from different classes without success.
You and your doctor may already be discussing alternative treatments, such as Transcranial Magnetic Stimulation (TMS.) But you may also be curious to know what causes TRD.
Here are some tips to help you understand why not everyone responds to traditional treatments.


Depression is a complex human disorder that doctors only partly understand. It is caused by a variety of factors, includes various subsets (such as anxiety) and is expressed by many symptoms.
Therefore, no two patients experience depression in quite the same way, nor can they be treated the same.
This makes it challenging for doctors to accurately diagnose and treat patients. Only one-third of depressed patients achieve remission with their first trial of antidepressant medication. Finding the right treatment is often a system of trial and error.

As your doctor works on treating the symptoms of your TRD, here are some contributing factors they will explore:

  • Misdiagnosis of symptoms
  • Needed adjustments to medication
  • Medical issues, such as metabolic abnormalities, anemia or thyroid problems
  • Substance abuse. Sleeping and eating disorders
  • Interactions with other medications
  • Life situations affecting patient’s depression
  • Patient not following treatment protocol

Strategies for Relief

In an effort to address TRD, doctors may try different approaches to adjust your medication to suit your needs. These may include:

  • Giving your medication more time. Doctors typically allow up to 10 weeks to fully assess a drug’s effectiveness.
  • Switching to a different medication, usually in another drug class
  • Adding a non-antidepressant medication to address other medical concerns
  • Adding another antidepressant to your medication regimen
  • Increasing or reducing the dosage

After making these changes with your doctor and typically over a period of eight months or more, 33 percent of people still do not achieve relief from their TRD symptoms. If nothing seems to work, you and your doctor can discuss alternative treatment options.

These can include TMS, a safe, non-invasive treatment for people diagnosed with TRD. TMS delivers highly focused magnetic fields to stimulate underactive nerve cells in the brain and relieve depression symptoms.
Talk with your doctor if you feel you are suffering from TRD. Together, you can design a treatment plan or discuss alternative options such as TMS to get the relief you need.

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