Alisha Verly Jensen
Mental health and wellness writer
Reviewed by Hanna Silva
Lic. Psychologist
Oct. 5, 2023
“It’s been a long journey. I didn’t understand why I felt the way I did. I was down all the time. No matter what was happening around me, I just felt guilty and worthless. On my worst days, I would just stay in my bedroom. I finally got help – and a diagnosis. I was depressed. The label gave me some relief – if I am sick that means I can be cured. So I began medication. The first prescription was too strong and gave me bad side effects. The second one seemed to have no effect. I’ve been on my latest treatment for six months, and my symptoms haven’t improved much. I feel like I am up against a brick wall. I keep pushing, but it feels like I haven’t moved an inch.”
Anonymous
If you have had a similar experience, you are not alone. One out of every three people with major depressive disorder does not respond to antidepressants, despite trying at least two different types and taking them for at least six weeks.
When this happens, the condition is considered treatment-resistant. However, this doesn’t mean that your depression is incurable. Instead, it signals that other treatment options may be more effective.
What Treatment-resistant Depression Is – and What It Isn’t
Treatment resistance is a medically specific term that can only be diagnosed by a mental health professional. That’s because treating depression is a complicated, trial-and-error process full of starts and stops. There are many scenarios that could seem like treatment resistance but aren’t.
For example, you might need to try your medication at various doses before seeing any results. This doesn’t mean you are treatment-resistant. Having to stop treatment early because of intolerable side effects is also not considered treatment resistance.
To make it even more confusing, it is common for people to go through multiple depressive episodes in their lifetime. Depression relapse is defined as the return of depressive symptoms after a sustained symptom-free period. This is different from treatment resistance, where the person doesn't feel relief from their symptoms.
Why Does Treatment Resistance Happen?
“I tried antidepressants for years, but nothing seemed to work. My psychiatrist suggested I add a mood stabilizer to my treatment. My recovery was almost instant but temporary. I want to raise my dose, but I am concerned about the side effects. It’s a balancing act.”
Anonymous
Treatment resistance is common, and there are numerous reasons why people don’t respond to antidepressants.
One reason is that depression is a condition caused by a mixture of biological, psychological, and social factors. Antidepressants solely target biological factors. This may not be enough for people who have developed depression in response to their environment or their thinking processes.
Also, antidepressants, like other medications, are less effective in specific situations. Mixing antidepressants with alcohol or common over-the-counter medications, like birth control or blood thinners, can alter their function.
Other medical conditions can increase the likelihood of treatment resistance. For example, treatment-resistant depression tends to appear more often in people with autoimmune disorders, thyroid disease, heart disease, cerebrovascular disease, and chronic stress.
Finally, treatment resistance may happen simply because our understanding of depression is still growing. Every discovery leads to new treatment options, combinations, and protocols. That means more alternatives and better chances for recovery.
“In my struggle with treatment-resistant depression, I’ve learned one thing – cultivate healthy lifestyle habits and try every treatment option open to you.”
Anonymous
Hope for Treatment-Resistant Depression
Whether you’ve been grappling with depression for months or years, dealing with treatment resistance can feel defeating. It’s natural to wonder if you’ll ever find relief. But don’t despair. There are a variety of effective non-medication depression treatments that you can try. One of the most powerful is neuromodulation.
Neuromodulation techniques use electric currents or magnets to encourage activity in specific brain areas. Some types of neuromodulation, like electroconvulsive therapy (ECT) or vagus nerve therapy (VNT), require general anesthesia, surgery, or implanted devices. While effective, these treatments are only recommended as a last resort.
Non-invasive methods like TMS and tDCS have little to no side effects. They work by delivering gentle stimulation through external devices worn on the head. Both TMS and tDCS work as standalone treatments. They can also be combined with antidepressants and make them more effective.
The Flow tDCS headset, the only brain stimulation device approved for home use, is available without a prescription. Undergoing tDCS at home eliminates many of the issues that contribute to failed treatments, such as missed sessions or lengthy wait times.
Flow tDCS can help people who haven’t responded to other treatment types – people like Annie, who struggled with severe depression throughout her teens. Flow tDCS gave her the relief she needed to regain control over her life. Hear her story: Annie’s story
Flow has helped thousands of people, many of whom have lived with treatment-resistant depression for years. Here are a few more powerful stories of users who found a lifeline in Flow:
“I’ve had depression for four years. Medication helped, but it didn’t make my symptoms go away. The drugs also gave me terrible side effects that made it difficult for me to work. I tried Flow because I was losing hope and running out of options. Since I started six weeks ago, I have noticed so much improvement! My mood is more relaxed, and some of the antidepressant side effects have stopped. My depression is far less severe. The combination of tDCS and following the CBT therapy guide in the Flow app has really helped me. I recommend Flow to my friends because I truly believe it's a lifesaver.”
Flow user
“When I first tried Flow I was skeptical. None of the medications or therapies I tried before seemed to work. It’s been less than 3 weeks and I already feel the difference in my well being. I highly recommend trying Flow, I cannot thank them enough!”
Flow user
“My son has severe depression and has tried every medication. He says Flow is the only thing that helps.”
Flow customer
“I have treatment-resistant depression and complex trauma-related anxiety. I tried months of CBT and yet another antidepressant that did little for my symptoms but gave me lots of side effects. I read about Flow, and it really was my last hope. I am on week 8 of the Flow treatment and realised my depression is gone…I am the same old me, but without the darkness that has been part of my life for so long. I am off the antidepressants and have enthusiasm for life.”
Flow user
Learn more about tDCS and the Flow headset.
Sources
Chan VKY, Luo H, Chan SSM, Lau CS, Yeung WWY, Peng K, Tong X, Lam MPS, Wong ICK, Li X. Treatment-resistant depression and risk of autoimmune diseases: evidence from a population-based cohort and nested case-control study. Transl Psychiatry. 2023 Mar 3;13(1):76.
Maneeton B, Maneeton N, Woottiluk P, Likhitsathian S. Repetitive Transcranial Magnetic Stimulation Combined with Antidepressants for the First Episode of Major Depressive Disorder. Curr Neuropharmacol. 2020;18(9):852-860.
Rakesh, Gopalkumar & Cordero, Patrick & Khanal, Rebika & Himelhoch, Seth & Rush, Craig. (2022). Combining Transcranial Magnetic Stimulation with Antidepressants: A Systematic Review and Meta-Analysis.
Margus Lõokene, Nikola Markov, Mika Nikander, Tuomas Neuvonen, Dancho Dilkov. Reduction of symptoms in patients with major depressive disorder after transcranial direct current stimulation treatment: A real-world study. Journal of Affective Disorders Reports, Volume 8, 2022, 100347, ISSN 2666-9153.
https://www.hopkinsmedicine.org/health/wellness-and-prevention/why-arent-my-antidepressants-working