The causes behind treatment-resistant depression aren’t clear but current studies have shown potential risk factors. These include brain and body risk factors, family history and genetics, and lifestyle factors.
Brain & Body Risk Factors
Let’s take a look at some of the factors that may precede treatment-resistant depression.
Other Underlying Health Issues
Depression can be comorbid with certain physical conditions. These include heart disease, gastrointestinal problems, and hypertension. Treatment-resistant depression has also been strongly associated with chronic non-cancer pain conditions. Mental health conditions such as eating disorders, substance abuse, post-traumatic stress disorder, and personality disorders can also occur alongside depression. Some studies have even found treatment-resistant depression to be a risk factor for developing other mental health conditions. Researchers in Sweden examined 121,699 patients between the ages of 18 and 69 with a diagnosis of major depressive disorder.
Metabolic Abnormalities
Clinical investigations have also determined that nutritional deficiencies and metabolic disorders can play a role in treatment-resistant depression. One study examined the blood, urine, and cerebrospinal fluid of 33 participants with treatment-resistant depression. It found that 21 of the participants had metabolic abnormalities, with folate (vitamin B9) deficiency being the most common.
Family History & Genetics
Individuals with a family history of depression have a higher likelihood of developing clinical depression themselves over the course of their lifetime. Studies have made this connection for clinical depression as a whole, but have not examined the family history risk factors for treatment-resistant depression specifically.
Lifestyle Risk Factors
Some lifestyle factors can put you at risk for treatment-resistant depression.
Misdiagnosis
Unfortunately, misdiagnosis is a common occurrence with mental health conditions. This can be due to symptoms overlapping with several possible diagnoses, which occurs frequently with mental disorders. Furthermore, individuals with bipolar disorder are often misdiagnosed with depression. In a study of 466 patients in psychiatric units diagnosed with major depressive disorder, 57% reported hypomanic symptoms when screened, suggestive of a misdiagnosis.
Problems With Medication
Antidepressants can take up to six weeks to work. Individuals often stop taking a drug too early, before the medication has time to take full effect. Some people may also skip doses or stop medications prematurely due to unpleasant side effects. Antidepressants can also have different effects from person to person. What provides significant relief for one may be insufficient for another, so it’s important to try different medications and different doses until you figure out what works best.
Diagnosis
Treatment-resistant depression is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, most mental health professionals consider a diagnosis when there have been at least two failed treatment attempts.
Treatment
Approximately 20% to 40% of individuals with major depression do not exhibit a clinical improvement with antidepressants.
Your Doctor May Recommend a Different Medication
If the medication is an issue, your doctor may prescribe a different antidepressant or add another to your current one. These can change your brain chemistry with the goal of bringing about desired relief.
the level of compliance with the current treatment regimenthe amount of time you took the medicationthe dosage
Cognitive-Behavioral Therapy
Your doctor may also refer you to a mental health professional if you aren’t already attending psychotherapy. Cognitive-behavioral therapy has been shown to be especially beneficial for treatment-resistant depression. This type of therapy can help reframe thought patterns and improve sleep issues.
Other Treatment Types
Additional treatments for treatment-resistant depression include vagus nerve stimulation (VNS), electroconvulsive therapy (ECT), and ketamine.
How to Cope With Treatment-Resistant Depression
Dealing with treatment-resistant depression can be challenging. If you are dealing with treatment-resistant depression, here’s what you can do to cope:
Prioritize self-care. Do your best to eat healthily, get enough sleep, and exercise regularly. Each of these actions can help reduce some of your depressive symptoms. Manage your stress. Life will inevitably have ongoing pressures, but it’s essential to engage in stress reduction techniques to help alleviate your worries. These can include journaling, meditation, or yoga. Ditch drugs and alcohol. These substances can make your symptoms worse and may interact with the current medications you are taking. Adhere to your treatment plan. Both therapy and medications can take time before you notice improvements. It’s important to stick to these parts of your treatment plan so they have the chance to take full effect.
