Treatment-Resistant Depression

At Mind + Body Medicine in Dallas, Texas, we deeply understand the complexities and challenges that come with living with Treatment-Resistant Depression (TRD). Our dedicated team, led by Dr. Howard Cohen, is committed to supporting patients in the Dallas Fort Worth area, as well as those from surrounding communities in the Southwest, as they navigate this difficult condition. Recognizing that each individual's experience with TRD is unique, we employ a comprehensive, interdisciplinary approach to care. This approach integrates various modalities to develop personalized treatment plans, including the latest in medical treatments, psychotherapy, and lifestyle strategies. Our goal is to alleviate the symptoms of TRD and enhance overall well-being and quality of life for our patients.

Find relief from Treatment-Resistant Depression. 

What Is Treatment-Resistant Depression?

Treatment-resistant depression (TRD) is a form of major depressive disorder (MDD) that remains unresponsive to conventional antidepressant treatments.1 TRD typically is considered when two or more antidepressant therapies, including SSRIs or SNRIs, fail to alleviate the symptoms after a sufficient period of treatment.2

TRD Symptoms

TRD encompasses similar symptoms of depression, such as persistent low mood, sleep disturbances, and changes in appetite. However, individuals with TRD often experience more severe and longer-lasting depressive episodes, increased anhedonia (inability to feel pleasure), frequent episodes, heightened anxiety, and a greater risk of suicidal thoughts and behaviors.

Potential Causes of TRD

The exact cause of TRD is not entirely understood, but it's believed to involve complex interactions of genetic, biochemical, and environmental factors. Chronic stress, for instance, can alter the hypothalamic-pituitary-adrenal (HPA) axis, impacting the body's stress response and exacerbating depressive symptoms.

TRD Risk Factors

Certain physical health conditions are more common in individuals with TRD compared to those with non-resistant MDD. These include autoimmune disorders, neurologic disorders, thyroid issues, heart disease, and cerebrovascular diseases.3

TRD Diagnosis and Treatment

Diagnosing TRD involves a comprehensive evaluation of mental and physical health, medication history, and response to previous treatments. Our approach at Mind + Body Medicine includes:

  • Medication management; continuing or adjusting current medications
  • Combining different classes of antidepressants
  • Correcting any sleep disorders and/or hormonal imbalances
  • Incorporating psychotherapy and/or cognitive behavioral therapy (CBT)4
  • Considering FDA-approved medications that normalize brain chemistry and reduce neuroinflammation, such as Aripiprazole, Brexpiprazole, Quetiapine, and Olanzapine
  • Looking at cutting-edge FDA-approved therapies such as Ketamine infusion therapy5 and Esketamine nasal spray6
  • Exploring advanced treatments like ECT, rTMS, DBS, VNS, and newer options like lithium augmentation, MAOIs, and Pramipexole
  • Combining approaches proven to be beneficial such as rTMS with Ketamine or newer MAOIs with Ketamine treatment
  • Review promising experimental therapies such as Stanford Neuromodulation Therapy (SNT), a rapid TMS protocol, Deep Brain Stimulation (DBS), Vagal Nerve Stimulation (VNS), transcranial Direct Current Stimulation tDCS, Magnetic Seizure Therapy (MST) photobiomodulation, and Psilocybin therapy
  • Weighing the benefits of inpatient hospitalization, partial hospitalization (PHP), intensive outpatient programs (IOP), and chronic pain rehabilitation programs

Additional Supportive Strategies

Beyond medical depression treatments, we help manage TRD symptoms by encouraging lifestyle modifications and coping strategies such as:

  • Regular physical activity

  • Quality sleep routines

  • Stress management techniques, including mindfulness, meditation, and yoga

  • Nutritional support with amino acid and vitamin analogues

  • Eating a balanced diet and avoiding depressant substances like alcohol

  • Maintaining social connections and support networks

FAQs About TRD

How common is TRD?

TRD affects a significant portion of individuals diagnosed with MDD. Approximately 30% of those who have tried standard antidepressant medications for MDD find themselves grappling with TRD.

What makes depression 'treatment-resistant'?

Depression is considered treatment-resistant when symptoms do not improve after the adequate use of at least two different antidepressants, each taken for a sufficient duration (usually 6-8 weeks) and at an appropriate dosage.

Are there specific symptoms that indicate TRD?

Symptoms of TRD are similar to those of MDD, but often more severe. These include persistent sadness, sleep disturbances, and changes in appetite. Individuals with TRD might also experience longer depressive episodes and increased anhedonia (inability to experience pleasure).

Are mood disorders a risk factor for treatment-resistant depression?

Yes, mood disorders are considered a risk factor for TRD.7 Various mental health conditions, including bipolar disorder and obsessive-compulsive disorder (OCD), can complicate the treatment of depression, potentially leading to resistance to standard treatments. Bipolar disorder, especially bipolar depression, can sometimes be misdiagnosed as major depressive disorder, leading to inappropriate treatment strategies that may not effectively address the unique needs of bipolar depression. This misdiagnosis can contribute to treatment resistance. Post-traumatic stress disorder (PTSD) is another mental health condition that can intersect with depression. The presence of PTSD can complicate the clinical picture, necessitating a more nuanced approach to treatment which, if not adequately provided, may lead to TRD. Our health professionals are well-versed in mental health care, including psychiatric care, and are aware of the interplay between these various conditions and depression. This understanding is crucial in devising effective treatment plans for each patient’s unique case. This is particularly important in cases like postpartum depression, where hormonal and situational factors combine with existing mental health conditions, potentially increasing the likelihood of developing TRD.

Can lifestyle changes impact TRD?

Yes, lifestyle changes such as regular physical activity, adequate sleep, stress management, and maintaining social connections can complement medical treatments and help manage symptoms of TRD. Furthermore, diet is also an important factor; the Mediterranean diet, ketogenic diets, and fermented foods have been shown to help manage TRD.

Is it possible to recover from TRD?

While TRD can be challenging to treat, many individuals find relief with the right combination of therapies. Recovery is a gradual process and might involve trying different treatments to find what works best.

How long does it take to see improvement in TRD?

The response time to treatment in TRD can vary. Some treatments might show effects within a few weeks, while others may take longer. Patience and ongoing communication with your healthcare provider are key.

Can TRD lead to other health issues?

Yes, untreated or poorly managed TRD can lead to a range of physical and mental health issues, including increased risk of chronic diseases, anxiety disorders, and a significantly impacted quality of life.

Schedule A Consultation

Ready to take the first step towards a healthier, more balanced life? Schedule your consultation with Mind + Body Medicine in Dallas, TX, today. Our expert team is here to guide patients in Dallas, Fort Worth, DFW, Texas, and beyond through every step of your journey toward wellness. Contact us now to discover how our personalized, multidisciplinary approach can make a difference in your life. Don’t let a mood disorder define you. Let's work together to find your path to relief and well-being. Call us or visit our website to book your appointment. Your journey to better mental health starts here!

1 Mayo Clinic. Treatment-resistant depression. Available: https://www.mayoclinic.org/diseases-conditions/depression/in-depth/treatment-resistant-depression/art-20044324. Accessed January 10, 2024.
2 Neuropsychiatric Disease and Treatment. Management of Treatment-Resistant Depression: Challenges and Strategies. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6982454/. Accessed January 10, 2024.
3 Cleveland Clinic. Treatment-Resistant Depression. Available: https://my.clevelandclinic.org/health/diseases/24991-treatment-resistant-depression. Accessed January 10, 2024.
4 Johns Hopkins Medicine. Treatment-Resistant Depression. Available: https://www.hopkinsmedicine.org/health/conditions-and-diseases/mood-disorders/treatment-resistant-depression. Accessed January 10, 2024.
5 Harvard Health Publishing. Ketamine for treatment-resistant depression: When and where is it safe? Available: https://www.health.harvard.edu/blog/ketamine-for-treatment-resistant-depression-when-and-where-is-it-safe-202208092797. Accessed January 10, 2024.
6 Current Neuropharmacology. The Role of Ketamine in Treatment-Resistant Depression: A Systematic Review. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4243034/. Accessed January 10, 2024.
7 The Journal of Clinical Psychiatry. Available: https://www.psychiatrist.com/jcp/predictors-risk-factors-treatment-resistant-depression-systematic-review/#. Accessed January 10, 2024.