Ok, I'm first going to say that I am not at all trying to insult anyone who may have this diagnosis. I'm just trying to understand it.

The thing is, the accepted definition of Treatment-Resistant Depression is if at least 2 different anti-depressants haven't worked for the person. But the thing is, at least in my opinion, anti-depressants aren't necessarily the best treatment for depression. Therapy seems to be better, or even a combination of the two.

Plus, the individuals have to come to mind. This is not meant to be insulting at all, but I imagine that certain individuals are more able to overcome their illness. Not necessarily because it's less severe, but because of different factors. Perspective, how they were raised, support system, other diagnoses, etc.

It just seems to me, I guess, that not responding to 2 different anti-depressants would be pretty common in the mental health system, and so a large percentage of people could potentially have TRD. But really, is it that the depression is resistant to treatment? Or is it that the treatment itself isn't good enough?

Any thoughts are appreciated, as always.

[Leed]

Hi ~ There could be a number of reasons that enter into it. Just because 2 different medications didn't work doesn't mean that the 3rd one won't. There are lots of meds out there. I've tried a couple that didn't work, so I kept trying more until we found one that DID work!

Prozac worked great for me until it stopped working -- after awhile you tend to "get used" to the medication, and it loses it's potency. So we switched to Cymbalta and that works great! So that's what I'm on now. I can't remember the names of the ones I'd tried before that didn't work. But I DON'T think the doctors should STOP at two!!! They should KEEP trying until they find one that DOES work. Sheeesh!

Yes, therapy is great but sometimes it isn't enough. At least that is what I found. I've been depressed since childhood -- perhaps I was when I was born, who knows. LOL ALL my sisters and I are depressed. I've been in and out of therapy all my adult life. We delved into the dark recesses of my life and got into everything! And even getting all that out into the open and dealing with it -- it didn't help the depression, so medication was the last option. I also spent 2 weeks in a mental ward of a hospital due to extreme depression. After being put on medication, I was FINE. I finally found out what feeling "normal" was all about! LOL

So if your doctor quit trying medication at TWO -- I think I'd switch doctors. There IS a medication out there that WILL help you. And only YOU can decide if your therapist isn't good enough. If you feel like you're getting enough feed-back & guidance then he/she is probably ok. But if you're not, then find someone who WILL give that to you. I've had to switch therapists before and I was glad I did.

God bless and best of luck. Hugs, Lee

[venusss]

I am risking to sound offensive, but here is my take. Mental illness, or emotional troubles.... is not a character flaw. HOWEVER, the way you deal with it is.

ADs can work in the way... that they are mind altering drugs. But that is all. They can take the edge off, or whatever. But they will not live your life for you. They will not give you any meaning and purpose. YOU have to do it. And in many cases finding that "something" can help one overcome their troubles (even without drugs). That is not to say you will be happy-happy-happy if you do things... but rather you will be more comfortable in your skin.

So drugs can work, if you are willing to do some work yourself. They can work if you have good support system that will nudge you in the right direction. If you live in some hellhole, with horrible husband and horrible job and none of it satisfies you, you come from a horrible family and never really learned how to cope with life... and then go to GP who throws AD at you in 15 minute slot, kthnxbai... then chances are, it will not work...

Depression is a complex, very complex issue. It could be partly genetic. Part can be nutrition and life style. Part is probably spiritual and existential. Life situation contributes.... it is not "like diabetes" and purely genetic.

That said...I think everybody has shot at life. Even people with horrible upbringing and long time emotional struggles... if they are willing to be open to solutions and changes and doing things... whatever it is. Important thing is though... while you shouldn't be afraid to ask for help, you need to be the one in charge of your life and not expect others take care of you. Just because you struggle, doesn't mean you are broken and one should not be dehumanized for it (which I think the term TRD does in major way).

[akekaomen]

Diagnostic Definitions in Mental health are really not worth much. They are based on some statistics that are done and only provide a mean by which to measure one way or another. I didn't respond to at least 5 combos of meds and my current set is not working much either. Therapy is a joke for those who are in the middle of the harshest depression. Changing your thoughts is nearly impossible when your thoughts are out of control and you can't keep from thinking bad things. It's taxing and wears on you emotionally and physically.

If you can pull yourself out of your depression, count yourself lucky. Most of us just muddle through and hope we don't lose our jobs or family while trying to pretend to be functional. Eventually that breaks down and the hospital is the only option which will prescribe something to help get you back into a frame of mind that is possible to be treated.

So don't take definitions seriously in mental health. They don't fit most situations as they are derived as a statistical analysis of many different experiences. There may be a common thread, but remember, symptoms are given different weights as well. This is why I can't go to a support group for what's affecting my daughter. She has symptoms that fit about 3 to 4 diagnosis and as a 12 year old, it's impossible to determine which one it could be. So my wife and I have no support group specific to my daughter's illness, just her symptoms to live with.

Sorry, but I'm not feeling well myself and can't help but post stupid things when I'm depressed.

Thank you for your replies.

I wanted to point out that this post isn't about me personally...I'm diagnosed with Bipolar Disorder. I posted because the label confused me and I wanted to get other points of view on it.

[bipolarmedstudent]

I think treatment-resistant depression is just a synonym for 'difficult-to-treat' or 'atypically-responding' depression. I think it's kind of a handy term for doctors to use between each other. For example, if I was a family doctor, and I had a patient come to me who was depressed, I would probably try them on two different SSRI's. Or maybe an SSRI and an SNRI. If both drugs failed, that would be time for me to refer the patient on to a psychiatrist. In my referral letter I would write "Referring a patient to you for treatment-resistant depression. Patient has failed two SSRIs: Paxil and Zoloft."

It's just kind of a short-hand for saying 'hey, pay attention, this patient isn't responding as expected to treatment. we need to look further."

That's my perspective as a med student, anyway.

[RunningEagleRuns]

read my signature

[sunangel803]

Wow, the definition of TRD is pretty narrow. I must have really TRD in that case, because I've been on more meds/combos of meds than I can remember at the moment

Research has shown that depression responds best to a combination of meds and talk therapy.

[nicoleb2]

Wow, failing two meds equals treatment resistant?

How about those of us who are in therapy, and have had meds work for a short time, but develop a tolerance very quickly and then have to try more and more meds? I have tried more meds than I can count. Some work for a while, some not at all. I develop a tolerance fast... guess I am "Treatment resistant".... very, very treatment resistant