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At least 1/3 of the time depression doesn’t respond to the first medication tried.  If another attempt doesn’t work, it becomes “treatment resistant depression.”

If your depression isn’t lifting, here are ten ideas you might want to consider:

1) It might not be depression proper.  Bipolar depression – depression associated with the mood disorder Bipolar – does not respond like unipolar depression to antidepressants, and may instead require mood stabilizers.

One analysis says that up to one fourth of treatment resistant depression may be bipolar in nature.

2) Physical factors absolutely must be checked for, something that many doctors miss.  One study showed that perhaps half of people with depression have low levels of folic acid. Deficiency of Vitamin B12 is another common nutritional reason for depression.

A wide variety of digestive disorders may also cause depressive like symptoms or contribute to resistance to medications.  Evaluation of nutritional intake and very importantly how the body processes it is essential.

3) Thyroid problems often cause depressive like symptoms.  Even when treated, hypothyroidism can contribute to depression if the replacement hormones aren’t carefully chosen.  Adrenal problems are also very common along with conditions like hypoglycemia.

Treatment resistant depression is a strong reason to undergo testing for physiological issues that are implicated in depression.

4) Your depression may not go away if you still experience stressful life events and/or feel a lot of pressure.  Remember, depression can be a natural response to what’s going on in your life, and in that case, the only way to help it is by dealing with the root causes.

5) Switching medication is very common, especially considering how often initial treatments fail.  SSRIs are the first used medications, then alternative modern medications like SNRIs or DNRIs.  If those fail, tricylcic or MAO inhibitors are used.

It’s almost normal for your first try to not work.  Don’t give up or get discouraged.  Try different types of medication in different combinations.

It’s essential to have a doctor who understands the details of the antidepressants and give you proper guidance.

6) For very serious depression that doesn’t respond to treatment, electroconvulsive therapy might be worth considering. ECT, though it has side effects, may be the most effective treatment for depression with efficacy rates around 75%.

7) Lithium or other mood stabilizers alongside antidepressants might help.  They’ve shown excellent results in some studies – 45% response versus 11% for placebo. Patience is key; it takes 3-4 weeks and careful monitoring to achieve results.

8) Anti-psychotics also increase recovery rates, but they have significant side effects such as sedation, weight gain and possibly irreversible tics, so use is cautioned.

9) Stimulants like Ritalin and Adderall have shown mixed results. Theoretically, someone who is depressed and lacks energy might get a motivating kick from stimulants. In one study of 60 patients, 40% on Ritalin improved as opposed to 23% not, a statistically insignificant difference.

10) Don’t forget therapy.  An increasing amount of people just take antidepressants without seeing a therapist.  This means they miss the chance to work on the issues causing them to be depressed.

11) Extra point:  Exercise can help revitalize you.

Remember: Never give up

Never give up.  With the right combination of therapy, medication, exercise and dietary modification, things will improve.  Depression can rob you of the ability to see that there is hope.  There is a future, and you have the power to make it better, but you need to get the right help.

If you are experiencing suicidal thoughts right now, or do in the future, please consider getting immediate help. You can call 1-800-273-TALK or other hotlines to talk to someone right now.

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Sources:

Treatment-Resistant Depression: Recent Development And Future Directions
Treatment-Resistant Depression, Souery, Papakostas and Trivedi