For people with treatment resistant depression

I now understand that the trials and tribulations of people who suffer from treatment resistant depression can be a unique and debilitating journey.

We offer this new forum in hopes of helping such folks exchange ideas, experiences and emotional support for this concern.

Best,
DocJohn

Thank you. That would be me. Apparently some people view it as a defeatist attitude to say you are treatment resistant. I see it as reality for me. 20 years of treatment of all kinds backs it up.

I don't know whether I'm treatment resistant, I've only had a partial response to meds this time around, despite having tried 7 different antidepressants in three years (2 poop outs, 1 allergy and 2 with unmanageable side effects). I've responded well to meds in the past, so I'm really discouraged that this time nothing seems to work. It certainly adds to the hopelessness that's for sure.

I am not sure of the exact definition. If it has only to do with meds or with meds and therapy and other treatments. I can say all of the above. Not that things have never worked or haven't helped me it is just that the depression keeps returning and even worse in recent years.

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As far as meds go, I have been on five different meds in one year. I am still basically depressed. Most of these meds did not work so well. Effexor may have worked but it made me sleep all the time. Buspar, which is supposed to be for anxiety, gave me anxiety and made my heart race. Wellbutrin seems to be working the best so far but I still have days when I feel down and hopeless. I could not afford a therapist, though that would probably be helpful. Now I just try to manage one day at a time. I don't know what else to do. Thanks for this forum.

I think a clear definition would be helpful, because there does seem to be some confusion around the term. Here's what I've found to be of note:

1. The term "treatment-resistant" specifically describes major depressive disorder that has not been relieved by full cycle use of at least two different anti-depressants. That's actually the entire definition. (Source.)

2. A person is not treatment-resistant. This is important to note, as saying "I'm treatment resistant" or "you're treatment resistant" implies a personal fault that the definition is clearly not meant to imply.

3. What seems to often be meant by some in their use of the term treatment-resistant, is the phenomena of psychological resistance in therapy, however when that becomes maladaptive over time it is actually considered to be the result of behaviors exhibited by both the subject and the therapist. (Source.) I mention this because it's interesting the degree of sole personal fault people often associate with this phenomena as well.

I had never thought about it that much to look into the definition further until I came to this forum, and heard people saying it about themselves and one another in a way that didn't make sense to me, as however consumed we may be by our condition at times: we are not our condition.

I'm so grateful for this new forum. It's sometimes hard to make any progress discussing depression issues in a "regular" depression setting when someone suggests a medication or a modality that I've tried multiple times, starting 15 years ago. Just like with breaking in new MH professionals, so much energy is expended explaining what has already been tried that there is little left to talk about anything current. It will be nice to have a place where that kind of orientation is unnecessary.

I've been treated for depression on and off since I was in my late teens, almost 40 years . My most recent episode has been virtually unrelenting for over 20 years. I am completely disabled. Like most of us, I have a number of other diagnoses, including PTSD, GAD, social phobia, and panic disorder with agoraphobia. I fit solidly into vonmoxie's first category, having attempted (and sometimes barely survived) scores of medication trials, a devastating course of ECT, and year upon year of assorted talk therapies.

I think vonmoxie's second point is really important for all of us to remember. One of my doctors once told me that the real problem is not that I'm doing something wrong, it's just that science hasn't caught up to me. Sometimes that's the only thought that keeps me going.

I guess I might be treatment resistant.

I've tried Celexa, Lexapro, wellbutrin, and also seroquel and Risperdal.

Just started taking Lamictal in April but I'm not at "therapeutic" levels yet, only at 100mg currently, so it's too early to tell. Just started taking buspar last week, also to early to tell.

The former meds have all ethier made me extremely suicidal, were ineffective, or made my anxiety sky rocket.

After 20 yrs and dozens of meds, I would say I'm "treatment resistant".

I find that a pretty incomplete and insufficient definition. It implies that anti depressants are some magic pills and that if you don't respond to two of them you are treatment resistant. We all know they are not magic pills and many people don't respond to them but may respond to therapy.

Am I treatment resistant?
I have been on many anti depressants over the last 20 years most of which have been totally ineffective. That would make me treatment resistant. However a couple have worked. Effexor with a low dose of Celexa worked pretty good for a long time. Effexor has been the best one for me but long ago pooped out. So we tried Pristiq and it didn't do anything. The latest one is Fetzima and it has been more effective than anything ever by far. It seems to be pooping already though. I have had to raise the dose once already and feel like I need to again and it has only been six months. So am I treatment resistant or not? I have no doubt that my recurrent cyclical depression will return fetzima or no fetzima like it always does.

This is why I think in the big picture I am treatment resistant-
Most meds don't work and the ones that do poop out. (thats a small part)
I have gone to much therapy and group therapy over the years. Always been 100% honest in therapy and in group.
I learned CBT in therapy and practice it everyday.
Started therapy again with someone who incorporates all the forms, CBT, DBT, and so on.
I practice mindfulness everyday.
Have very consistently meditated over the last twenty years.
Self help books and work books.
Spiritual books and practices.
Long time member of AA and practice its twelve steps and principles. Very similar to therapy with the added spiritual dimension. It is very focused on personal growth, changing thinking and behaviour, and spiritual growth. Have done my fair share of searching and fearless moral inventories and shared it all with someone.
Alanon, ACOA
A good support network.
A good fulfilling career.
Tons of exercise at work.

I am in no way perfect in these things but I have worked very hard at it. They have helped me immensely in daily living and in personal relationships and so on. I am not depressed all the time and it is when I am not depressed that they help. I am totally all for all those practices and they have helped me in general a ton.........

BUT I still get regular recurrent cyclical depression like I always have. it has gotten worse in recent years despite all these things that you would think would help alleviate it. When I am in the middle of a severe depression none of those things work even if I am able to practice them. I can be in the middle of working, getting lots of exercise, and everything is great and the depression will hit me like a ton of bricks out of the blue. It usually has to run its course and it always does. The length of time varies and it always returns. When it hits it is very severe. Suicidal, can't get out of bed, don't shower for weeks, severe.

What am I to do?
Whether that is treatment resistant I do not know. To me it is. It leads me to believe that in my case it is very genetically and biologically ingrained in me. it follows seasonal cycles. Not SAD but three or four times a year that I can set the calender by. There is also a family history that would back this up.

I'm surprised you would want to take it on in terms of "I am" -- are you, yourself, resisting treatment? Or is it simply the condition that been resistant to a cure?

I daresay that anyone whose depression could be considered treatment-resistant does not consider anti-depressants particularly magical. (50% success rate doesn't much speak to that either.) I understand that the terminology doesn't encompass everything that one might prefer to catalog as treatments that don't consistently work, but since the actual definition does only refer to the efficacy of anti-depressants it seems as though re-purposing the terminology in conversation to carry variant definitions could be cause for some misunderstanding, and about what can only be a sensitive topic for all of us.

Treatment-resistant depression
From Wikipedia, the free encyclopedia
Treatment-resistant depression Classification and external resources MeSH D061218

Treatment-resistant depression (TRD) or treatment-refractory depression is a term used in clinical psychiatry to describe cases of major depressive disorder (MDD) that do not respond adequately to adequate courses of at least two antidepressants.[1] The term was first coined with the development of the concept in 1974. Inadequate response has traditionally been defined as no response whatsoever. However, many clinicians consider a response inadequate if the patient does not achieve full remission of symptoms.[2] Cases of treatment-resistant depression in which the course of treatment was not adequate are sometimes referred to as pseudoresistant.[3] Some factors that contribute to inadequate treatment are: early discontinuation of treatment, insufficient dosage of medication, patient noncompliance, misdiagnosis, and concurrent psychiatric disorders.[3] Cases of treatment-resistant depression may also be referred to by which medications they are resistant to (i.e.: SSRI-resistant).[4]

Prevalence
Treatment-resistance is relatively common in cases of MDD. Rates of total remission following antidepressant treatment are only 50.4%. In cases of depression treated by a primary-care physician, 32% of patients partially responded to treatment and 45% did not respond at all.[2]

I'm not suggesting that those of us with treatment-resistant depression not talk about all the things that do (ha) and don't work for us. I am suggesting there's an inherent value in knowing and utilizing the meaning of already established terminology. I don't myself much want to be described with words that were only ever meant to describe my condition's resistance to a family of drugs that only has 50% efficacy anyway. Depressed as I am, I'm better than that.

I would say I'm treatment resistant. Am on my 6th antidepressant since August 2013 and am now hopeful to start ECT for my severe depression on Monday.

BTW, thanks for this new forum. Helpful for us folks are struggling to find a treatment that works.

By the definition of treatment resistant depression meaning having been thru more than 2 different meds in one year that did not work, that definition would apply to me. I am in a state now where I am not really happy, I guess I just don't care anymore. Too tired to care. I have days like today when I have some work related anxiety, but even that is slipping into the "I don't care anymore" state.

My depression has been considered treatment-resistant for a long time now. I have tried 35+ different medications, in every class of drug imaginable.
I even tried ECT (which did nothing but cause me severe memory loss issues).
I was on an almost lethal combination of meds at one point due to an incompetent psychiatrist.
I'm still going to therapy and doing everything I can to fight it, but the depression fights hard to win.

I have tried everything out there over the last 21 years. No joy.

I am not saying it in a way that I am letting it define me. I don't have a problem with labels in general that may apply to me or let them define me.

Your point is well taken. Definitions and commonly agreed upon terminology is very important and we need them in order to communicate. I still think it is dated and narrow in its definition. Not that it matters but still not sure if it applies to me. I have not responded adequately to adequate courses of at least two antidepressants, and more than that but I have responded adequately to some. Based on the exact definition from 1974 it is not a very useful term in my view.

My post was more about a rant/diatribe on the protracted nature of my depression and pouring out my frustrations with it.

I was initially struck with the first paragraph of this thread by DocJohn.

Trials, tribulations, journey, unique, debilitating. I would be interested to know what the context of his thinking was on the term when he wrote that. I read more into that then the failure of two SSRI's for example, but I was reading into it.

Sorry, I didn't mean to leave a debate open about exactly what "treatment resistant depression" means.

To me, and in this context, it means you've tried multiple treatment options -- whether it be psychotherapy, meds, ECT, TMS, whatever -- over a period of years and despite your (and your professionals') best efforts and multiple tries on different treatments (whether it be with different therapists, therapies, meds, etc.), very little has touched your depression. You are still depressed. It doesn't seem to have responded much to anything.

That's my definition. I'm going to close this thread to encourage you all to start new threads here on the topics of the most interest to you...

Thanks!

Best,
DocJohn

I also moved some posts that weren't about the definition of TRD into their own thread so those members may continue their discussion there if they would like.