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He also conducts original research on posttraumatic stress and emotional regulation in clinical disorders, teaches university courses on related topics, and he helps train psychiatry residents in a medical school setting.</p>\n<p><strong>Education</strong></p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Santa Clara University, BA</span></li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">University of Colorado Denver, MA</span></li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">University of Nevada, Reno, PhD</span></li>\n</ul>\n<p><strong>Certifications</strong></p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Licensed Clinical Psychologist</span></li>\n</ul>\n<p><strong>Professional Accomplishments</strong></p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Completed clinical research fellowship at the University of California, San Diego</span></li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Completed clinical internship at New Mexico VA/Southwest Consortium</span></li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Featured in informational videos on topics in mental health as “Dr. Matt B”</span></li>\n</ul>\n<p><strong>Affiliations</strong></p>\n<ul>\n<li style=\"font-weight: 400;\"><a href=\"https://www.psychologicalscience.org/\"><span style=\"font-weight: 400;\">Association for Psychological Science (APS)</span></a></li>\n<li style=\"font-weight: 400;\"><a href=\"https://www.apa.org/about/division/div56\"><span style=\"font-weight: 400;\">American Psychological Association (APA), Division 56 Trauma Psychology</span></a></li>\n<li style=\"font-weight: 400;\"><a href=\"https://www.isre.org/\"><span style=\"font-weight: 400;\">International Society for Research in Emotion (ISRE)</span></a></li>\n</ul>\n"},"avatar":{"title":"","width":500,"height":500,"src":"https://post.psychcentral.com/wp-content/uploads/2024/07/New-Matthew-Boland-500x500-Bio.png"}}],"id":"psy-29197","updateReason":[],"editor":"Stephanie Orford","factCheckedBy":"","factCheckers":[],"articleHistory":{"2021-04-01":{"updateReason":[],"authors":"Morgan Meissner, PhD","editor":"Stephanie Orford","copyEditor":"Douglas Backstrom","medicallyReviewedBy":"Matthew Boland, PhD"}},"articleDates":{"factChecked":{"date":null,"display":""},"medicallyReviewed":{"date":1617264960,"display":"April 1, 2021"},"published":{"date":1617264960,"display":"April 1, 2021"},"lastUpdates":{"date":1617264960,"display":"April 1, 2021"},"modified":{"date":1730832734,"display":"November 5, 2024"}},"type":"healthfeature","language":"en"},"cesData":{"metaDescription":"If you're living with treatment-resistant depression, there are a few alternative treatments to consider.","title":"Treatment-Resistant Depression: Options, Strategies, and More","iab_tag_tier_1":["301"],"iab_tag_tier_2":["301"],"mpdTags":[{"confidence":0.9859797334014767,"type":"topic_level_1","value":"health"},{"confidence":0.7728490949475073,"type":"topic_level_2","value":"neurology"},{"confidence":0.5228400163982888,"type":"topic_level_3","value":"mental_health_disorders"},{"confidence":0.24985983492166217,"type":"topic_level_4","value":"depression"},{"confidence":0.45804641564171233,"type":"entity","value":"resistant depression"}]},"relatedStories":false,"wellness":false,"infiniteScroll":true,"infScrollArticles":[{"title":["Can Saffron Be Used as an Antidepressant?"],"text":["Saffron can be used to treat depressive symptoms. 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class="css-pdceuf"><div class="css-11egx89"><button class="icon-hl-close-thick css-1ik4tkj"></button><div data-empty="true" class="css-1fteite"><div class="css-1hjaa0k"><span class="css-zya54r"></span></div><div id="mlb1__slot" data-adbridg-ad-class="mlb1" data-ad="true" class="css-bcus5s"></div></div></div></aside><div data-placement="subheader"></div><div><div class="css-m260rd"><div data-article-body="0" class="css-blwnmv"><div class="css-z468a2"><h1>What To Do When Your Antidepressant Isn’t Helping Enough</h1><div data-preamp="social-proof-lessons"></div><div data-testid="byline"><section data-testid="byline" class="css-eoj89x"><div class="css-1q67gt9"><div class="css-xc63cd"><img src="//i0.wp.com/post.psychcentral.com/wp-content/uploads/2024/07/New-Matthew-Boland-500x500-Bio.png?w=105&h=105" alt=""/></div></div><div><span><span>Medically reviewed by <a class="css-150s69f css-130mbve" href="https://www.psychcentral.com/reviewers/matthew-boland-phd">Matthew Boland, PhD</a></span></span> — <span><span><span><span>Written by <a class="css-150s69f css-130mbve" href="https://www.psychcentral.com/authors/morgan-meissner">Morgan Meissner, PhD</a></span></span></span></span> <span> on April 1, 2021</span></div></section></div><div><nav id="tab-bar-0" data-testid="tab-bar" class="css-7u7i0a"><ul class="css-17ztj4b"><li class="css-t753mo"><a href="#what-is-treatment-resistant-depression" class="css-yn6ido">What is treatment-resistant depression?</a></li><li class="css-t753mo"><a href="#medication-strategies" class="css-yn6ido">Medication strategies</a></li><li class="css-t753mo"><a href="#therapy" class="css-yn6ido">Therapy</a></li><li class="css-t753mo"><a href="#if-therapy-isnt-working" class="css-yn6ido">If therapy isn't working</a></li><li class="css-t753mo"><a href="#brain-stimulation" class="css-yn6ido">Brain stimulation</a></li><li class="css-t753mo"><a href="#living-with-depression" class="css-yn6ido">Living with depression</a></li><li class="css-t753mo"><a href="#recap" class="css-yn6ido">Recap</a></li></ul></nav><article class="article-body css-d2znx6 undefined"><div class="css-12va8w7"><span style="font-size:0;line-height:0"></span><span style="font-size:0;line-height:0"></span><div><div><p class="css-w2pt6r">Treatment-resistant depression is when you’re taking medication for depression symptoms, but it isn’t working as well as you need it to. If you’re living with this condition, there are a few alternative treatments to consider.</p></div></div><div><p>Depression that doesn’t respond well to antidepressants is known as treatment-resistant depression.</p></div><div><div data-preamp="serena-chatbot"></div></div><div><p><hl-trusted-source source="PubMed Central" rationale="Highly respected database from the National Institutes of Health"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582308/" target="_blank" rel="noopener noreferrer" class="content-link css-150s69f">About half</a></hl-trusted-source> of people experiencing depression symptoms may see a slight or no improvement when they take antidepressants. This leaves lingering symptoms that can strain your mental, emotional, and physical well-being.</p></div><div><p>However, there are steps you can take to effectively manage symptoms of depression.</p></div><div class="css-20w1gi"><aside class="css-0 css-0" data-testid="sticky-inline-ad" data-sticky="false"><div><div data-empty="true" class="css-1sq15os"><div class="css-1hjaa0k"><span class="css-zya54r"></span></div><div id="inline2__slot" data-adbridg-ad-class="inline2__slot" data-ad="true" class="css-1t05dkn"></div></div></div></aside></div></div><div class="css-1avyp1d"><span style="font-size:0;line-height:0"></span><div><h2><div><a class="chartbeat-section" name="what-is-treatment-resistant-depression">What is treatment-resistant depression?</a></div></h2></div><span style="font-size:0;line-height:0"></span><div><p>Experts say depression is treatment-resistant when your symptoms haven’t improved after you’ve tried two antidepressants. You must have taken them at the optimal dose for an appropriate amount of time to see an effect, usually about 4 to 6 weeks.</p></div><div><p>If a healthcare professional has prescribed you two or more antidepressants and your depression symptoms persist, speak with a psychiatrist.</p></div><div><p>If you started your medication regimen with a psychiatrist or psychiatric nurse practitioner, ask them about the possibility of trying different solutions.</p></div><div><h3>What to expect with a psychiatrist</h3></div><div><p>A psychiatrist may begin asking questions to learn more about you. They may be particularly interested in finding out if you:</p></div><div><ul><li>also have an anxiety or personality disorder</li><li>smoke or use recreational drugs</li><li>have other chronic, nonpsychiatric conditions, such as autoimmune diseases</li></ul></div><div><p>These conditions and behaviors are common among people experiencing treatment-resistant depression. Addressing them may improve your response to treatment.</p></div><div><p>To get a more complete picture of your health, the psychiatrist may also order <a href="https://www.psychcentral.com/depression/blood-test-for-depression" class="content-link css-150s69f">blood work</a>, such as:</p></div><div><ul><li>a complete blood count</li><li>liver and kidney function tests</li><li>lipid and glucose tests</li><li>a thyroid test</li></ul></div><div><p>They may also ask questions to assess the symptoms and their severity to track how these change over time.</p></div><div><p>These questions can also help determine whether the treatment resistance you’re experiencing is due to an undiagnosed, underlying condition.</p></div><div><p>For example, bipolar disorder is common among people experiencing treatment-resistant depression.</p></div><span class="css-zya54r"></span></div><div class="css-1avyp1d"><span style="font-size:0;line-height:0"></span><div><h2><div><a class="chartbeat-section" name="medication-strategies">Medication strategies</a></div></h2></div><span style="font-size:0;line-height:0"></span><div><p>You still have several options when it comes to medication for treatment-resistant depression.</p></div><div><h3>Antidepressants</h3></div><div><p>Even if you’ve experienced resistance to antidepressants so far, they might still work for you.</p></div><div><p>Your healthcare professional may try optimizing your current treatment by giving it more time to work or increasing the dose.</p></div><div><p>Different classes of antidepressants work in different ways, so your psychiatrist may also consider switching you to a different class of antidepressant.</p></div><div><p>Some common classes of antidepressant include:</p></div><div><ul><li>selective serotonin reuptake inhibitors (SSRIs)</li><li>dual serotonin and norepinephrine reuptake inhibitors (SNRIs)</li><li>tricyclic antidepressants (TCAs)</li><li>monoamine oxidase inhibitors (MAOIs)</li></ul></div><div><p>Doctors and psychiatrists generally start people experiencing symptoms first on an SSRI, so if you’re experiencing treatment-resistant depression, you may have already tried an antidepressant from this category.</p></div><div><p>People who don’t respond to an SSRI may experience improved symptoms once they switch to a TCA, MAOI, or certain SNRIs, according to <hl-trusted-source source="PubMed Central" rationale="Highly respected database from the National Institutes of Health"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582308/" target="_blank" rel="noopener noreferrer" class="content-link css-150s69f">research</a></hl-trusted-source>. </p></div><div><h3>Adjuvant treatments</h3></div><div><p>Your doctor may also try adding another medication alongside your antidepressant to boost effectiveness. Healthcare professionals call this augmentation or adjuvant treatment.</p></div><div><p>Some common adjuvants include:</p></div><div><ul><li>lithium</li><li>thyroid hormone (T3)</li><li>a second-generation antipsychotic, such as quetiapine, aripiprazole, olanzapine, or risperidone</li><li>benzodiazepines or hydroxyzine, for people with anxiety</li><li>a hypnotic, such as zolpidem or zopiclone, if you have trouble sleeping</li></ul></div><div><p>Your psychiatrist may also consider combining treatments to help treat your condition from multiple angles.</p></div><div><h3>Ketamine</h3></div><div><p>In recent years, the drug ketamine has emerged as a potential option for treatment-resistant depression.</p></div><div><p>Healthcare professionals originally used it as an anesthetic. However, new <hl-trusted-source source="PubMed Central" rationale="Highly respected database from the National Institutes of Health"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7730956/" target="_blank" rel="noopener noreferrer" class="content-link css-150s69f">research</a></hl-trusted-source> has found that ketamine acts as a pain reliever and sedative at lower doses and exerts multiple effects on the parts of the brain associated with depression.</p></div><div><p>One <hl-trusted-source source="PubMed Central" rationale="Highly respected database from the National Institutes of Health"><a href="https://pubmed.ncbi.nlm.nih.gov/33706168/" target="_blank" rel="noopener noreferrer" class="content-link css-150s69f">systematic review</a></hl-trusted-source> of studies showed that it is generally safe for adults and that you may experience relief from depression symptoms as soon as <a href="https://www.sciencedirect.com/science/article/abs/pii/S0165032720327026?via%3Dihub" target="_blank" rel="noopener noreferrer" class="content-link css-150s69f">4 hours</a> after using it.</p></div><div><p>However, researchers know less about its effects in older people, children, and teenagers. More research is needed.</p></div><div><p>Research has shown that ketamine infusions are effective, but the drug is also available as a nasal spray.</p></div><div><p>Because the use of <a href="https://www.psychcentral.com/depression/ketamines-for-depression" class="content-link css-150s69f">ketamine to treat depression</a> symptoms is so new, there isn’t a standard protocol for how or when you should use it.</p></div><div><p>Generally, though, ketamine is reserved for people experiencing severe symptoms of treatment-resistant depression who need immediate relief, such as those at risk of suicide.</p></div><div class="css-20w1gi"><aside class="css-0 css-0" data-testid="sticky-inline-ad" data-sticky="false"><div><div data-empty="true" class="css-1sq15os"><div class="css-1hjaa0k"><span class="css-zya54r"></span></div><div id="inline7__slot" data-adbridg-ad-class="inline7__slot" data-ad="true" class="css-1t05dkn"></div></div></div></aside></div></div><div class="css-1avyp1d"><span style="font-size:0;line-height:0"></span><div><h2><div><a class="chartbeat-section" name="therapy">Therapy</a></div></h2></div><span style="font-size:0;line-height:0"></span><div><p>Getting psychological counseling can help address the many ways depression symptoms affect your life, including your emotional, social, and physical health.</p></div><div><p>People may call this psychotherapy, counseling, or talk therapy.</p></div><div><p>The goal of counseling is to discover the core issues underlying your symptoms and equip you with the tools to improve your sense of well-being and relieve feelings of distress.</p></div><div><p>Counseling can help you with decision-making skills, maintaining healthy relationships, stress management and coping techniques, and developing a healthy self-esteem.</p></div><div><p><hl-trusted-source source="BMC/BioMed Central" rationale="Peer reviewed journal"><a href="https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-019-2237-x" target="_blank" rel="noopener noreferrer" class="content-link css-150s69f">Experts</a></hl-trusted-source> say the goals of psychotherapy or counseling are to:</p></div><div><ul><li>equip you with the tools to recognize when your symptoms are getting worse</li><li>help you develop coping strategies for stressful situations</li><li>provide psychological support for the symptoms of depression</li><li>provide education about your condition</li><li>help you stick with treatment recommendations</li><li>manage other psychiatric conditions, such as anxiety or substance use disorder</li></ul></div><div><p>The top two points in this list may be the most effective for helping you relieve symptoms.</p></div><span class="css-zya54r"></span></div><div class="css-1avyp1d"><span style="font-size:0;line-height:0"></span><div><h2><div><a class="chartbeat-section" name="if-therapy-isnt-working">What to try if therapy isn’t working</a></div></h2></div><span style="font-size:0;line-height:0"></span><div><p>Counseling with a support therapist who listens well and provides occasional unstructured validation or advice does not tend to help people experiencing symptoms of depression.</p></div><div><p>However, some specific psychotherapy techniques may be effective.</p></div><div><p>These may be even more beneficial if you receive them at the same time as you take antidepressant medications.</p></div><div><p><hl-trusted-source source="PubMed Central" rationale="Highly respected database from the National Institutes of Health"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6494651/" target="_blank" rel="noopener noreferrer" class="content-link css-150s69f">Research</a></hl-trusted-source> suggests that combining psychotherapy and antidepressant treatment improves or resolves symptoms in people experiencing treatment-resistant depression better than taking antidepressants independently.</p></div><div><p>According to the <a href="https://www.apa.org/depression-guideline/guideline.pdf" target="_blank" rel="noopener noreferrer" class="content-link css-150s69f">American Psychological Association (APA)</a>, most people experiencing treatment-resistant depression benefit from a combination of medication and psychotherapy.</p></div><div><h3>Cognitive behavioral therapy</h3></div><div><p>Cognitive behavioral therapy (CBT) is a form of psychotherapy that focuses on changing your mental and behavioral responses to stress.</p></div><div><p>CBT is powerful because it also helps you respond to factors that contribute to depression. It may help you change negative thought patterns and engage in meaningful activities or behaviors.</p></div><div><p>This type of therapy empowers you to act as your own therapist so you can continue helping yourself over the long term.</p></div><div><p>One study looked at the effects of combining CBT and antidepressant medications. Those who received both were more than <hl-trusted-source source="The Lancet" rationale="Highly respected journal,Expert written journal,Peer reviewed journal"><a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61552-9/fulltext" target="_blank" rel="noopener noreferrer" class="content-link css-150s69f">3 times</a></hl-trusted-source> as likely to show long-term improvements in depression symptoms as those who took just antidepressants.</p></div><div><p>Even if you stop taking medication for depression symptoms, the skills you learned in CBT continue to help you throughout life.</p></div><div class="css-20w1gi"><aside class="css-0 css-0" data-testid="sticky-inline-ad" data-sticky="false"><div><div data-empty="true" class="css-1sq15os"><div class="css-1hjaa0k"><span class="css-zya54r"></span></div><div id="inline12__slot" data-adbridg-ad-class="inline12__slot" data-ad="true" class="css-1t05dkn"></div></div></div></aside></div></div><div class="css-1avyp1d"><span style="font-size:0;line-height:0"></span><div><h2><div><a class="chartbeat-section" name="brain-stimulation">Brain stimulation</a></div></h2></div><span style="font-size:0;line-height:0"></span><div><p>Doctors reserve brain stimulation procedures as a last resort for people who have not responded well to multiple antidepressants or therapy.</p></div><div><p>If you decide to try this treatment, a doctor will stimulate parts of your brain with electricity.</p></div><div><p>Electroconvulsive therapy (ECT) is the type of brain stimulation researchers have studied most. Healthcare professionals have used it since the early 1900s to treat mental health conditions.</p></div><div><p>Although portrayals of ECT in pop culture have often been negative, <hl-trusted-source source="PubMed Central" rationale="Highly respected database from the National Institutes of Health"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6982454/" target="_blank" rel="noopener noreferrer" class="content-link css-150s69f">studies</a></hl-trusted-source> suggest that it can provide relief for many people who don’t respond to antidepressants.</p></div><div><p>ECT is also very safe in its modern form — an important point to consider if you’re wondering whether you should get it.</p></div><div><p>The <a href="https://www.apa.org/depression-guideline/guideline.pdf" target="_blank" rel="noopener noreferrer" class="content-link css-150s69f">APA</a> generally recommends that doctors reserve ECT for people experiencing severe treatment-resistant depression, such as those who are experiencing suicidal thoughts or also experiencing psychosis.</p></div><div><p>If ECT doesn’t work to resolve symptoms, your doctor may recommend trying other brain stimulation techniques, such as:</p></div><div><ul><li>repetitive transcranial magnetic stimulation (rTMS)</li><li>vagus nerve stimulation (VNS)</li><li>deep brain stimulation</li></ul></div><span class="css-zya54r"></span></div><div class="css-1avyp1d"><span style="font-size:0;line-height:0"></span><div><h2><div><a class="chartbeat-section" name="living-with-depression">Living with treatment-resistant depression</a></div></h2></div><span style="font-size:0;line-height:0"></span><div><p>There are many small steps you can take to help manage your symptoms of depression.</p></div><div><h3>Stick to your treatment plan</h3></div><div><p>Even if you feel better, it’s advisable to keep taking your medications as prescribed and continue going to therapy. Depression symptoms could return if you stop treatment.</p></div><div><p>If you have concerns about your medications, such as side effects that you don’t like, your psychiatrist may have other options.</p></div><div><h3>Stress management techniques</h3></div><div><p>Therapy can help you develop skills to cope with stress in a healthy, productive way.</p></div><div><p>It can also help you manage particular factors related to depression, such as negative thought patterns or lack of enjoyment or motivation.</p></div><div><h3>Self-care helps</h3></div><div><p><a href="https://academic.oup.com/nutritionreviews/advance-article/doi/10.1093/nutrit/nuaa118/6000409?login=true" target="_blank" rel="noopener noreferrer" class="content-link css-150s69f">Research</a> suggests that people who eat a diet rich in fruits and vegetables are less likely to experience depression symptoms. It also recommends physical activity as a complement to antidepressant treatment.</p></div><div><p>If you drink alcohol, smoke, or take recreational drugs, consider quitting. This may reduce symptoms of depression.</p></div><div><p>If you feel you need support for a substance use disorder, your healthcare professional may help.</p></div><div><div id="widget_call_out_8484c029-65ce-4392-beea-3a135c721e95" class="css-ubcbi5"><span style="font-size:0;line-height:0"></span><div class="css-14hk5xp"><div class="css-xqvouu"><h3 class="css-9zytxy"><div><span class="css-14sy2z4">Are you in a crisis or considering suicide?</span></div></h3><div class="css-slwzda"><p>If you or someone you know is considering suicide or self-harm, help is available:</p><ul><li>Text or call 988, or chat <a href="http://988lifeline.org" target="_blank" rel="noopener noreferrer" class="content-link css-150s69f">988lifeline.org</a>.</li><li>Text “HOME” to the <a href="https://www.crisistextline.org/?gclid=EAIaIQobChMIsPDQrdXH5wIVBRx9Ch1YdQjIEAAYASAAEgJ_1_D_BwE" target="_blank" rel="noopener noreferrer" class="content-link css-150s69f">Crisis Textline</a> at 741741.</li><li>Not in the United States? Find a helpline in your country with <a href="https://www.befrienders.org/" target="_blank" rel="noopener noreferrer" class="content-link css-150s69f">Befrienders Worldwide</a>.</li><li>If it’s an emergency, call or visit your local emergency room or psychiatric care center to speak with a mental health professional.</li></ul></div></div></div><div class="css-1uwjw6e"><div></div><div></div></div></div></div></div><div class="css-1avyp1d"><span style="font-size:0;line-height:0"></span><div><h2><div><a class="chartbeat-section" name="recap">Recap</a></div></h2></div><span style="font-size:0;line-height:0"></span><div><p>If you’re experiencing treatment-resistant depression, you may feel frustrated and disheartened, but there is hope.</p></div><div><p>Changing your antidepressant medication and getting counseling or therapy may help ease your symptoms.</p></div><div><p>If you’ve tried multiple kinds of medications and your depression symptoms are still affecting your life, your healthcare professional may have other treatments available.</p></div></div></article><span class="css-zya54r"></span></div><div><div class="css-w9ag5x"><div class="css-1xn3edc"><div aria-expanded="false" aria-controls="article-resources" class="css-1l48sh1" role="button"><p class="css-1dxissy"><span class="css-1p6d3md icon-hlvideo-minus"></span><span class="css-1p6d3md icon-hlvideo-plus"></span> <span class="css-1xdhyk6">15 sources</span><span class="sro">collapsed</span></p></div><div id="article-resources" role="region" class="css-1ugaz02"><ul class="css-1vedeqe"><li class="css-f6pdvi"><cite><span>Alshammari TK. (2020). The ketamine antidepressant story: New insights.</span><br/><a class="css-150s69f css-138ocmy" target="_blank" rel="noopener noreferrer" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7730956/">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7730956/</a></cite></li><li class="css-f6pdvi"><cite><span>Bennabi D, et al. (2019). Clinical guidelines for the management of treatment-resistant depression: French recommendations from experts, the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental.</span><br/><a class="css-150s69f css-138ocmy" target="_blank" rel="noopener noreferrer" href="https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-019-2237-x">https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-019-2237-x</a></cite></li><li class="css-f6pdvi"><cite><span>Counseling psychology. (2008).</span><br/><a class="css-150s69f css-138ocmy" target="_blank" rel="noopener noreferrer" href="https://www.apa.org/ed/graduate/specialize/counseling">https://www.apa.org/ed/graduate/specialize/counseling</a></cite></li><li class="css-f6pdvi"><cite><span>Clinical practice guideline for the treatment of depression across three age cohorts. (2019).</span><br/><a class="css-150s69f css-138ocmy" target="_blank" rel="noopener noreferrer" href="https://www.apa.org/depression-guideline/guideline.pdf">https://www.apa.org/depression-guideline/guideline.pdf</a></cite></li><li class="css-f6pdvi"><cite><span>Di Vincenzo JD, et al. (2021). The effectiveness, safety and tolerability of ketamine for depression in adolescents and older adults: A systematic review.</span><br/><a class="css-150s69f css-138ocmy" target="_blank" rel="noopener noreferrer" href="https://pubmed.ncbi.nlm.nih.gov/33706168/">https://pubmed.ncbi.nlm.nih.gov/33706168/</a></cite></li><li class="css-f6pdvi"><cite><span>Gordon J. (2019). New hope for treatment-resistant depression: Guessing right on ketamine.</span><br/><a class="css-150s69f css-138ocmy" target="_blank" rel="noopener noreferrer" href="https://www.nimh.nih.gov/about/director/messages/2019/new-hope-for-treatment-resistant-depression-guessing-right-on-ketamine.shtml">https://www.nimh.nih.gov/about/director/messages/2019/new-hope-for-treatment-resistant-depression-guessing-right-on-ketamine.shtml</a></cite></li><li class="css-f6pdvi"><cite><span>Ijaz S, et al. (2018). Psychological therapies for treatment‐resistant depression in adults.</span><br/><a class="css-150s69f css-138ocmy" target="_blank" rel="noopener noreferrer" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6494651/">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6494651/</a></cite></li><li class="css-f6pdvi"><cite><span>Marcantoni WS, et al. (2020). A systematic review and meta-analysis of the efficacy of intravenous ketamine infusion for treatment resistant depression: January 2009 – January 2019.</span><br/><a class="css-150s69f css-138ocmy" target="_blank" rel="noopener noreferrer" href="https://www.sciencedirect.com/science/article/abs/pii/S0165032720327026?via%3Dihub">https://www.sciencedirect.com/science/article/abs/pii/S0165032720327026?via%3Dihub</a></cite></li><li class="css-f6pdvi"><cite><span>Perugi G, et al. (2019). Patterns of response to antidepressants in major depressive disorder: Drug resistance or worsening of depression are associated with a bipolar diathesis.</span><br/><a class="css-150s69f css-138ocmy" target="_blank" rel="noopener noreferrer" href="https://www.sciencedirect.com/science/article/abs/pii/S0924977X19302597?via%3Dihub">https://www.sciencedirect.com/science/article/abs/pii/S0924977X19302597?via%3Dihub</a></cite></li><li class="css-f6pdvi"><cite><span>Sharma V, et al. (2005). A closer look at treatment resistant depression: Is it due to a bipolar diathesis?</span><br/><a class="css-150s69f css-138ocmy" target="_blank" rel="noopener noreferrer" href="https://www.sciencedirect.com/science/article/abs/pii/S0165032704000862?via%3Dihub">https://www.sciencedirect.com/science/article/abs/pii/S0165032704000862?via%3Dihub</a></cite></li><li class="css-f6pdvi"><cite><span>Tundo A, et al. (2015). Pharmacologic approaches to treatment resistant depression: Evidences and personal experience.</span><br/><a class="css-150s69f css-138ocmy" target="_blank" rel="noopener noreferrer" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582308/">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582308/</a></cite></li><li class="css-f6pdvi"><cite><span>Voineskos D, et al. (2020). Management of treatment-resistant depression: Challenges and strategies.</span><br/><a class="css-150s69f css-138ocmy" target="_blank" rel="noopener noreferrer" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6982454/">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6982454/</a></cite></li><li class="css-f6pdvi"><cite><span>What is cognitive behavioral therapy? (2017).</span><br/><a class="css-150s69f css-138ocmy" target="_blank" rel="noopener noreferrer" href="https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral">https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral</a></cite></li><li class="css-f6pdvi"><cite><span>Wiles N, et al. (2013). Cognitive behavioural therapy as an adjunct to pharmacotherapy for primary care based patients with treatment resistant depression: Results of the CoBalT randomised controlled trial.</span><br/><a class="css-150s69f css-138ocmy" target="_blank" rel="noopener noreferrer" href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61552-9/fulltext">https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61552-9/fulltext</a></cite></li><li class="css-f6pdvi"><cite><span>Wu PY, et al. (2020). Dietary patterns and depression risk in older adults: Systematic review and meta-analysis.</span><br/><a class="css-150s69f css-138ocmy" target="_blank" rel="noopener noreferrer" href="https://academic.oup.com/nutritionreviews/advance-article/doi/10.1093/nutrit/nuaa118/6000409?login=true">https://academic.oup.com/nutritionreviews/advance-article/doi/10.1093/nutrit/nuaa118/6000409?login=true</a></cite></li></ul></div></div><div class="css-1wkzy2"><div class="css-1ytasfq"><div class="button-wrapper print"><a class="css-1uhtj6l print button icon icon-hl-print" target="_blank" title="Print this page"></a></div><div class="button-wrapper facebook"><a class="css-1uhtj6l facebook button icon icon-hl-facebook" href="https://www.facebook.com/sharer/sharer.php?u=https%3A%2F%2Fpsychcentral.com%2Fdepression%2Ftreatment-resistant-depression%3Futm_medium%3Dsocial%26utm_source%3Dfacebook%26utm_campaign%3Dsocial-sharebar-referred-desktop" rel="noopener noreferrer nofollow" target="_blank" title="Share 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data-testid="title-link" data-ga4="Read Next button clicks">Can Saffron Be Used as an Antidepressant?</a><p class=""><a class="css-onvglr" data-event="engagement|bottom page content promo click|/depression/saffron-for-depression;engagement|bottom page content promo click index|1" data-element-event="INTERNAL LINK|FOOTER|Any Page|Read This Next|LINK|Can Saffron Be Used as an Antidepressant?|rn0" href="https://www.psychcentral.com/depression/saffron-for-depression?utm_source=ReadNext" data-testid="text-link" data-ga4="Read Next button clicks" aria-hidden="true" tabindex="-1">Saffron can be used to treat depressive symptoms. Discover the science behind its many benefits and how to incorporate it into your diet.</a></p><a class="css-1culwpr css-2dy712" data-event="engagement|bottom page content promo click|/depression/saffron-for-depression;engagement|bottom page content promo click index|1" data-element-event="INTERNAL LINK|FOOTER|Any Page|Read This Next|LINK|Can Saffron Be Used as an Antidepressant?|rn0" href="https://www.psychcentral.com/depression/saffron-for-depression?utm_source=ReadNext" data-ga4="Read Next button clicks">READ MORE<span class="icon-hl-arrow-right-bold selector css-2kgwd5"></span></a></div></div></div><section class="css-82r5pg css-1ub4i5m"><div data-empty="true" class="css-vhteyv"><div class="css-1hjaa0k"><span class="css-zya54r"></span></div><div id="DCMR1__slot" data-adbridg-ad-class="DCMR1" data-ad="true" class="css-prb4v6"></div></div></section></div></div></li><li class="css-12weawj"><div class="css-m260rd"><div class="css-1h1rean"><div class="css-1r7frvz"><span class="css-zya54r"></span></div><section class="css-82r5pg css-1ub4i5m"><div data-empty="true" class="css-vhteyv"><div class="css-1hjaa0k"><span class="css-zya54r"></span></div><div id="DCMR1__slot" data-adbridg-ad-class="DCMR1" data-ad="true" class="css-prb4v6"></div></div></section></div></div></li><li class="css-12weawj"><div class="css-m260rd"><div class="css-1h1rean"><div class="css-1r7frvz"><div class="css-lm0pdr"><span style="font-size:0;line-height:0"></span><figure class="css-1e4ja14 css-f0t0lw"><a class="css-1uhtj6l" data-event="engagement|bottom page content promo click|/depression/is-depression-neurodivergent;engagement|bottom page content promo click index|2" data-element-event="INTERNAL LINK|FOOTER|Any Page|Read This Next|LINK|Is Depression Neurodivergent?|rn1" href="https://www.psychcentral.com/depression/is-depression-neurodivergent?utm_source=ReadNext" aria-label="image-link" data-ga4="Read Next button clicks" data-testid="image-link" aria-hidden="true" tabindex="-1"><div class="css-79elbk"><span class="css-rwmw5v css-1pf0x3y"><span class="css-1767n2d"><lazy-image alt="Is Depression Neurodivergent?" src="https://media.post.rvohealth.io/wp-content/uploads/sites/4/2024/04/sad-depressed-man-sitting-on-bed-alone-732x549-thumbnail.jpg" srcSet="https://media.post.rvohealth.io/wp-content/uploads/sites/4/2024/04/sad-depressed-man-sitting-on-bed-alone-732x549-thumbnail.jpg 200w" className="css-1lyqwde"></lazy-image></span></span><span class="css-1fb1nmp"><span class="css-a10gts"></span></span></div></a></figure><div class="css-h0zs0i"><a class="css-11ivwxm" data-event="engagement|bottom page content promo click|/depression/is-depression-neurodivergent;engagement|bottom page content promo click index|2" data-element-event="INTERNAL LINK|FOOTER|Any Page|Read This Next|LINK|Is Depression Neurodivergent?|rn1" href="https://www.psychcentral.com/depression/is-depression-neurodivergent?utm_source=ReadNext" data-testid="title-link" data-ga4="Read Next button clicks">Is Depression Neurodivergent?</a><p class=""><a class="css-onvglr" data-event="engagement|bottom page content promo click|/depression/is-depression-neurodivergent;engagement|bottom page content promo click index|2" data-element-event="INTERNAL LINK|FOOTER|Any Page|Read This Next|LINK|Is Depression Neurodivergent?|rn1" href="https://www.psychcentral.com/depression/is-depression-neurodivergent?utm_source=ReadNext" data-testid="text-link" data-ga4="Read Next button clicks" aria-hidden="true" tabindex="-1">Depression is not recognized as a neurodivergent condition. Although depression and neurodivergence share similar aspects, they also differ in many…</a></p><a class="css-1culwpr css-2dy712" data-event="engagement|bottom page content promo click|/depression/is-depression-neurodivergent;engagement|bottom page content promo click index|2" data-element-event="INTERNAL LINK|FOOTER|Any Page|Read This Next|LINK|Is Depression Neurodivergent?|rn1" href="https://www.psychcentral.com/depression/is-depression-neurodivergent?utm_source=ReadNext" data-ga4="Read Next button clicks">READ MORE<span class="icon-hl-arrow-right-bold selector css-2kgwd5"></span></a></div></div></div><section class="css-82r5pg css-1ub4i5m"></section></div></div></li><li class="css-12weawj"><div class="css-m260rd"><div class="css-1h1rean"><div class="css-1r7frvz"><div class="css-lm0pdr"><span style="font-size:0;line-height:0"></span><figure class="css-1e4ja14 css-f0t0lw"><a class="css-1uhtj6l" data-event="engagement|bottom page content promo click|/depression/postpartum-depression-statistics;engagement|bottom page content promo click index|3" data-element-event="INTERNAL LINK|FOOTER|Any Page|Read This Next|LINK|Facts About Postpartum Depression|rn2" href="https://www.psychcentral.com/depression/postpartum-depression-statistics?utm_source=ReadNext" aria-label="image-link" data-ga4="Read Next button clicks" data-testid="image-link" aria-hidden="true" tabindex="-1"><div class="css-79elbk"><span class="css-rwmw5v css-1pf0x3y"><span class="css-1767n2d"><lazy-image alt="Facts About Postpartum Depression" src="https://media.post.rvohealth.io/wp-content/uploads/sites/4/2024/03/young-mother-standing-holding-baby-by-window-732x549-thumbnail.jpg" srcSet="https://media.post.rvohealth.io/wp-content/uploads/sites/4/2024/03/young-mother-standing-holding-baby-by-window-732x549-thumbnail.jpg 200w" className="css-1lyqwde"></lazy-image></span></span><span class="css-1fb1nmp"><span class="css-a10gts"></span></span></div></a></figure><div class="css-h0zs0i"><a class="css-11ivwxm" data-event="engagement|bottom page content promo click|/depression/postpartum-depression-statistics;engagement|bottom page content promo click index|3" data-element-event="INTERNAL LINK|FOOTER|Any Page|Read This Next|LINK|Facts About Postpartum Depression|rn2" href="https://www.psychcentral.com/depression/postpartum-depression-statistics?utm_source=ReadNext" data-testid="title-link" data-ga4="Read Next button clicks">Facts About Postpartum Depression</a><section data-testid="byline" class="css-ymf4ha"><div class="css-1pz7193"><div class="css-xc63cd"><lazy-image alt="" src="//i0.wp.com/post.psychcentral.com/wp-content/uploads/2022/01/Joslyn-Jelinek-500x500-Bio.png?w=73&h=73"></lazy-image></div></div><div><span><span>Medically reviewed by <a class="css-150s69f css-130mbve" href="https://www.psychcentral.com/medical-team">Joslyn Jelinek, LCSW, ACSW, RDDP</a></span></span></div></section><p class=""><a class="css-onvglr" data-event="engagement|bottom page content promo click|/depression/postpartum-depression-statistics;engagement|bottom page content promo click index|3" data-element-event="INTERNAL LINK|FOOTER|Any Page|Read This Next|LINK|Facts About Postpartum Depression|rn2" href="https://www.psychcentral.com/depression/postpartum-depression-statistics?utm_source=ReadNext" data-testid="text-link" data-ga4="Read Next button clicks" aria-hidden="true" tabindex="-1">Nearly 13% of women experience postpartum depression shortly after birth. But, non-pregnant and adoptive parents can also affected. Discover more here.</a></p><a class="css-1culwpr css-2dy712" data-event="engagement|bottom page content promo click|/depression/postpartum-depression-statistics;engagement|bottom page content promo click index|3" data-element-event="INTERNAL LINK|FOOTER|Any Page|Read This Next|LINK|Facts About Postpartum Depression|rn2" href="https://www.psychcentral.com/depression/postpartum-depression-statistics?utm_source=ReadNext" data-ga4="Read Next button clicks">READ MORE<span class="icon-hl-arrow-right-bold selector css-2kgwd5"></span></a></div></div></div><section class="css-82r5pg css-1ub4i5m"><div data-empty="true" class="css-vhteyv"><div class="css-1hjaa0k"><span class="css-zya54r"></span></div><div id="DCMR2__slot" data-adbridg-ad-class="DCMR2" data-ad="true" class="css-prb4v6"></div></div></section></div></div></li><li class="css-12weawj"><div class="css-m260rd"><div class="css-1h1rean"><div class="css-1r7frvz"><div class="css-lm0pdr"><span style="font-size:0;line-height:0"></span><figure class="css-1e4ja14 css-f0t0lw"><a class="css-1uhtj6l" data-event="engagement|bottom page content promo click|/health/i-cant-stop-crying;engagement|bottom page content promo click index|4" data-element-event="INTERNAL LINK|FOOTER|Any Page|Read This Next|LINK|Why Do I Cry So Often?|rn3" href="https://www.psychcentral.com/health/i-cant-stop-crying?utm_source=ReadNext" aria-label="image-link" data-ga4="Read Next button clicks" data-testid="image-link" aria-hidden="true" tabindex="-1"><div class="css-79elbk"><span class="css-rwmw5v css-1pf0x3y"><span class="css-1767n2d"><lazy-image alt="Why Do I Cry So Often?" src="https://media.post.rvohealth.io/wp-content/uploads/sites/4/2024/03/sad-man-crying-late-at-night-732x549-thumbnail.jpg" srcSet="https://media.post.rvohealth.io/wp-content/uploads/sites/4/2024/03/sad-man-crying-late-at-night-732x549-thumbnail.jpg 200w" className="css-1lyqwde"></lazy-image></span></span><span class="css-1fb1nmp"><span class="css-a10gts"></span></span></div></a></figure><div class="css-h0zs0i"><a class="css-11ivwxm" data-event="engagement|bottom page content promo click|/health/i-cant-stop-crying;engagement|bottom page content promo click index|4" data-element-event="INTERNAL LINK|FOOTER|Any Page|Read This Next|LINK|Why Do I Cry So Often?|rn3" href="https://www.psychcentral.com/health/i-cant-stop-crying?utm_source=ReadNext" data-testid="title-link" data-ga4="Read Next button clicks">Why Do I Cry So Often?</a><p class=""><a class="css-onvglr" data-event="engagement|bottom page content promo click|/health/i-cant-stop-crying;engagement|bottom page content promo click index|4" data-element-event="INTERNAL LINK|FOOTER|Any Page|Read This Next|LINK|Why Do I Cry So Often?|rn3" href="https://www.psychcentral.com/health/i-cant-stop-crying?utm_source=ReadNext" data-testid="text-link" data-ga4="Read Next button clicks" aria-hidden="true" tabindex="-1">Constant crying can be caused by stress or various health conditions. 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She holds a PhD in molecular biology and master\u0026#8217;s degree in bioinformatics. During her time in graduate school, Morgan realized that her true passions lie in science communication and outreach. Her goal as a writer is to translate complex medical and scientific ideas into a format that is clear, informative, and actionable for all. When she isn\u0026#8217;t behind her computer, Morgan enjoys spending time outdoors with her family and tackling new house projects. Find her on her \u003ca class=\"ProsemirrorEditor-link\" href=\"https://www.truenorthmedicalwriting.com/\"\u003ewebsite\u003c/a\u003e.\u003c/p\u003e\n"},"avatar":{"title":"","width":500,"height":500,"src":"https://post.psychcentral.com/wp-content/uploads/2022/10/Morgan-Meissner-500x500-Bio.png"},"bioBlurb":{"nodes":["Morgan Meissner is a medical writer based in central Minnesota. She holds a PhD in molecular biology and master’s degree in bioinformatics. During her time in…"]}}],"medicalReviewers":[{"id":4024,"name":{"display":"Matthew Boland, PhD","first":"Matthew","last":"Boland, PhD"},"userLogin":"mboland","links":{"website":"https://mattbphd.com/","facebook":"https://www.facebook.com/dr.mattb/","linkedin":"https://www.linkedin.com/in/matthew-boland-ph-d-9b527113/","twitter":"","instagram":"https://www.instagram.com/dr.mattb/","tiktok":""},"link":"/reviewers/matthew-boland-phd","type":{"value":"medical_reviewer","label":"Medical Advisor"},"nid":"164593","specialties":[],"guestTitle":"","bio":{"text":"\u003cp\u003eDr. Matt Boland is a licensed clinical psychologist who conducts structured assessment and psychotherapy with medical patients and mental health consumers in Reno, Nevada. He also conducts original research on posttraumatic stress and emotional regulation in clinical disorders, teaches university courses on related topics, and he helps train psychiatry residents in a medical school setting.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n\u003cli style=\"font-weight: 400;\"\u003e\u003cspan style=\"font-weight: 400;\"\u003eSanta Clara University, BA\u003c/span\u003e\u003c/li\u003e\n\u003cli style=\"font-weight: 400;\"\u003e\u003cspan style=\"font-weight: 400;\"\u003eUniversity of Colorado Denver, MA\u003c/span\u003e\u003c/li\u003e\n\u003cli style=\"font-weight: 400;\"\u003e\u003cspan style=\"font-weight: 400;\"\u003eUniversity of Nevada, Reno, PhD\u003c/span\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eCertifications\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n\u003cli style=\"font-weight: 400;\"\u003e\u003cspan style=\"font-weight: 400;\"\u003eLicensed Clinical Psychologist\u003c/span\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eProfessional Accomplishments\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n\u003cli style=\"font-weight: 400;\"\u003e\u003cspan style=\"font-weight: 400;\"\u003eCompleted clinical research fellowship at the University of California, San Diego\u003c/span\u003e\u003c/li\u003e\n\u003cli style=\"font-weight: 400;\"\u003e\u003cspan style=\"font-weight: 400;\"\u003eCompleted clinical internship at New Mexico VA/Southwest Consortium\u003c/span\u003e\u003c/li\u003e\n\u003cli style=\"font-weight: 400;\"\u003e\u003cspan style=\"font-weight: 400;\"\u003eFeatured in informational videos on topics in mental health as \u0026#8220;Dr. Matt B\u0026#8221;\u003c/span\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eAffiliations\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n\u003cli style=\"font-weight: 400;\"\u003e\u003ca href=\"https://www.psychologicalscience.org/\"\u003e\u003cspan style=\"font-weight: 400;\"\u003eAssociation for Psychological Science (APS)\u003c/span\u003e\u003c/a\u003e\u003c/li\u003e\n\u003cli style=\"font-weight: 400;\"\u003e\u003ca href=\"https://www.apa.org/about/division/div56\"\u003e\u003cspan style=\"font-weight: 400;\"\u003eAmerican Psychological Association (APA), Division 56 Trauma Psychology\u003c/span\u003e\u003c/a\u003e\u003c/li\u003e\n\u003cli style=\"font-weight: 400;\"\u003e\u003ca href=\"https://www.isre.org/\"\u003e\u003cspan style=\"font-weight: 400;\"\u003eInternational Society for Research in Emotion (ISRE)\u003c/span\u003e\u003c/a\u003e\u003c/li\u003e\n\u003c/ul\u003e\n"},"avatar":{"title":"","width":500,"height":500,"src":"https://post.psychcentral.com/wp-content/uploads/2024/07/New-Matthew-Boland-500x500-Bio.png"},"bioBlurb":{"nodes":["Dr. Matt Boland is a licensed clinical psychologist who conducts structured assessment and psychotherapy with medical patients and mental health consumers in…"]}}],"editors":[{"role":"Editor","name":{"display":"Stephanie Orford"}}],"pinterestImage":{"path":"https://media.post.rvohealth.io/wp-content/uploads/sites/4/2021/03/PC_Female_Portrait_732x549-thumbnail.jpg"},"hideFeedback":false,"isMedicare":false,"isBlog":false,"publishSource":"wordpress","isAmpSupported":false,"categories":[{"name":"content-marketing","slug":"content-marketing___en","link":"/content-marketing___en","primary":true,"children":[]}],"language":{"en":"https://psychcentral.com/depression/treatment-resistant-depression/","x-default":"https://psychcentral.com/depression/treatment-resistant-depression/","current":"en"},"lang":"en","links":[],"colorScheme":"default","isContentSeries":false,"brandCTAs":[],"clusterNavLinks":[],"clusterUrls":[],"clusterLinks":{},"pathingTilesData":{},"pathingCardsData":{},"inArticlePathingCardsData":[],"quantitativeTrustData":{},"isPrependRecipeH2":false,"recipes":[],"hideTabs":false,"tabs":[{"id":"_noHeaderPrefixedContent","title":null,"header":null,"body":[{"tagName":"div","source":"\u003cp class=\"css-w2pt6r\"\u003eTreatment-resistant depression is when you’re taking medication for depression symptoms, but it isn’t working as well as you need it to. If you’re living with this condition, there are a few alternative treatments to consider.\u003c/p\u003e"},{"tagName":"p","source":"Depression that doesn’t respond well to antidepressants is known as treatment-resistant depression."},{"tagName":"div","attributes":{"data-preamp":"serena-chatbot"},"source":""},{"tagName":"p","source":"\u003chl-trusted-source source=\"PubMed Central\" rationale=\"Highly respected database from the National Institutes of Health\"\u003e\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582308/\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"content-link css-150s69f\"\u003eAbout half\u003c/a\u003e\u003c/hl-trusted-source\u003e of people experiencing depression symptoms may see a slight or no improvement when they take antidepressants. This leaves lingering symptoms that can strain your mental, emotional, and physical well-being."},{"tagName":"p","source":"However, there are steps you can take to effectively manage symptoms of depression."}]},{"id":"what-is-treatment-resistant-depression","title":"What is treatment-resistant depression?","isCollapsable":false,"header":["What is treatment-resistant depression?"],"body":[{"tagName":"p","source":"Experts say depression is treatment-resistant when your symptoms haven’t improved after you’ve tried two antidepressants. You must have taken them at the optimal dose for an appropriate amount of time to see an effect, usually about 4 to 6 weeks."},{"tagName":"p","source":"If a healthcare professional has prescribed you two or more antidepressants and your depression symptoms persist, speak with a psychiatrist."},{"tagName":"p","source":"If you started your medication regimen with a psychiatrist or psychiatric nurse practitioner, ask them about the possibility of trying different solutions."},{"tagName":"h3","source":"What to expect with a psychiatrist"},{"tagName":"p","source":"A psychiatrist may begin asking questions to learn more about you. They may be particularly interested in finding out if you:"},{"tagName":"ul","source":"\u003cli\u003ealso have an anxiety or personality disorder\u003c/li\u003e\u003cli\u003esmoke or use recreational drugs\u003c/li\u003e\u003cli\u003ehave other chronic, nonpsychiatric conditions, such as autoimmune diseases\u003c/li\u003e"},{"tagName":"p","source":"These conditions and behaviors are common among people experiencing treatment-resistant depression. Addressing them may improve your response to treatment."},{"tagName":"p","source":"To get a more complete picture of your health, the psychiatrist may also order \u003ca href=\"https://www.psychcentral.com/depression/blood-test-for-depression\" class=\"content-link css-150s69f\"\u003eblood work\u003c/a\u003e, such as:"},{"tagName":"ul","source":"\u003cli\u003ea complete blood count\u003c/li\u003e\u003cli\u003eliver and kidney function tests\u003c/li\u003e\u003cli\u003elipid and glucose tests\u003c/li\u003e\u003cli\u003ea thyroid test\u003c/li\u003e"},{"tagName":"p","source":"They may also ask questions to assess the symptoms and their severity to track how these change over time."},{"tagName":"p","source":"These questions can also help determine whether the treatment resistance you’re experiencing is due to an undiagnosed, underlying condition."},{"tagName":"p","source":"For example, bipolar disorder is common among people experiencing treatment-resistant depression."}]},{"id":"medication-strategies","title":"Medication strategies","isCollapsable":false,"header":["Medication strategies"],"body":[{"tagName":"p","source":"You still have several options when it comes to medication for treatment-resistant depression."},{"tagName":"h3","source":"Antidepressants"},{"tagName":"p","source":"Even if you’ve experienced resistance to antidepressants so far, they might still work for you."},{"tagName":"p","source":"Your healthcare professional may try optimizing your current treatment by giving it more time to work or increasing the dose."},{"tagName":"p","source":"Different classes of antidepressants work in different ways, so your psychiatrist may also consider switching you to a different class of antidepressant."},{"tagName":"p","source":"Some common classes of antidepressant include:"},{"tagName":"ul","source":"\u003cli\u003eselective serotonin reuptake inhibitors (SSRIs)\u003c/li\u003e\u003cli\u003edual serotonin and norepinephrine reuptake inhibitors (SNRIs)\u003c/li\u003e\u003cli\u003etricyclic antidepressants (TCAs)\u003c/li\u003e\u003cli\u003emonoamine oxidase inhibitors (MAOIs)\u003c/li\u003e"},{"tagName":"p","source":"Doctors and psychiatrists generally start people experiencing symptoms first on an SSRI, so if you’re experiencing treatment-resistant depression, you may have already tried an antidepressant from this category."},{"tagName":"p","source":"People who don’t respond to an SSRI may experience improved symptoms once they switch to a TCA, MAOI, or certain SNRIs, according to \u003chl-trusted-source source=\"PubMed Central\" rationale=\"Highly respected database from the National Institutes of Health\"\u003e\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582308/\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"content-link css-150s69f\"\u003eresearch\u003c/a\u003e\u003c/hl-trusted-source\u003e. "},{"tagName":"h3","source":"Adjuvant treatments"},{"tagName":"p","source":"Your doctor may also try adding another medication alongside your antidepressant to boost effectiveness. Healthcare professionals call this augmentation or adjuvant treatment."},{"tagName":"p","source":"Some common adjuvants include:"},{"tagName":"ul","source":"\u003cli\u003elithium\u003c/li\u003e\u003cli\u003ethyroid hormone (T3)\u003c/li\u003e\u003cli\u003ea second-generation antipsychotic, such as quetiapine, aripiprazole, olanzapine, or risperidone\u003c/li\u003e\u003cli\u003ebenzodiazepines or hydroxyzine, for people with anxiety\u003c/li\u003e\u003cli\u003ea hypnotic, such as zolpidem or zopiclone, if you have trouble sleeping\u003c/li\u003e"},{"tagName":"p","source":"Your psychiatrist may also consider combining treatments to help treat your condition from multiple angles."},{"tagName":"h3","source":"Ketamine"},{"tagName":"p","source":"In recent years, the drug ketamine has emerged as a potential option for treatment-resistant depression."},{"tagName":"p","source":"Healthcare professionals originally used it as an anesthetic. However, new \u003chl-trusted-source source=\"PubMed Central\" rationale=\"Highly respected database from the National Institutes of Health\"\u003e\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7730956/\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"content-link css-150s69f\"\u003eresearch\u003c/a\u003e\u003c/hl-trusted-source\u003e has found that ketamine acts as a pain reliever and sedative at lower doses and exerts multiple effects on the parts of the brain associated with depression."},{"tagName":"p","source":"One \u003chl-trusted-source source=\"PubMed Central\" rationale=\"Highly respected database from the National Institutes of Health\"\u003e\u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/33706168/\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"content-link css-150s69f\"\u003esystematic review\u003c/a\u003e\u003c/hl-trusted-source\u003e of studies showed that it is generally safe for adults and that you may experience relief from depression symptoms as soon as \u003ca href=\"https://www.sciencedirect.com/science/article/abs/pii/S0165032720327026?via%3Dihub\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"content-link css-150s69f\"\u003e4 hours\u003c/a\u003e after using it."},{"tagName":"p","source":"However, researchers know less about its effects in older people, children, and teenagers. More research is needed."},{"tagName":"p","source":"Research has shown that ketamine infusions are effective, but the drug is also available as a nasal spray."},{"tagName":"p","source":"Because the use of \u003ca href=\"https://www.psychcentral.com/depression/ketamines-for-depression\" class=\"content-link css-150s69f\"\u003eketamine to treat depression\u003c/a\u003e symptoms is so new, there isn’t a standard protocol for how or when you should use it."},{"tagName":"p","source":"Generally, though, ketamine is reserved for people experiencing severe symptoms of treatment-resistant depression who need immediate relief, such as those at risk of suicide."}]},{"id":"therapy","title":"Therapy","isCollapsable":false,"header":["Therapy"],"body":[{"tagName":"p","source":"Getting psychological counseling can help address the many ways depression symptoms affect your life, including your emotional, social, and physical health."},{"tagName":"p","source":"People may call this psychotherapy, counseling, or talk therapy."},{"tagName":"p","source":"The goal of counseling is to discover the core issues underlying your symptoms and equip you with the tools to improve your sense of well-being and relieve feelings of distress."},{"tagName":"p","source":"Counseling can help you with decision-making skills, maintaining healthy relationships, stress management and coping techniques, and developing a healthy self-esteem."},{"tagName":"p","source":"\u003chl-trusted-source source=\"BMC/BioMed Central\" rationale=\"Peer reviewed journal\"\u003e\u003ca href=\"https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-019-2237-x\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"content-link css-150s69f\"\u003eExperts\u003c/a\u003e\u003c/hl-trusted-source\u003e say the goals of psychotherapy or counseling are to:"},{"tagName":"ul","source":"\u003cli\u003eequip you with the tools to recognize when your symptoms are getting worse\u003c/li\u003e\u003cli\u003ehelp you develop coping strategies for stressful situations\u003c/li\u003e\u003cli\u003eprovide psychological support for the symptoms of depression\u003c/li\u003e\u003cli\u003eprovide education about your condition\u003c/li\u003e\u003cli\u003ehelp you stick with treatment recommendations\u003c/li\u003e\u003cli\u003emanage other psychiatric conditions, such as anxiety or substance use disorder\u003c/li\u003e"},{"tagName":"p","source":"The top two points in this list may be the most effective for helping you relieve symptoms."}]},{"id":"if-therapy-isnt-working","title":"If therapy isn't working","isCollapsable":false,"header":["What to try if therapy isn’t working"],"body":[{"tagName":"p","source":"Counseling with a support therapist who listens well and provides occasional unstructured validation or advice does not tend to help people experiencing symptoms of depression."},{"tagName":"p","source":"However, some specific psychotherapy techniques may be effective."},{"tagName":"p","source":"These may be even more beneficial if you receive them at the same time as you take antidepressant medications."},{"tagName":"p","source":"\u003chl-trusted-source source=\"PubMed Central\" rationale=\"Highly respected database from the National Institutes of Health\"\u003e\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6494651/\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"content-link css-150s69f\"\u003eResearch\u003c/a\u003e\u003c/hl-trusted-source\u003e suggests that combining psychotherapy and antidepressant treatment improves or resolves symptoms in people experiencing treatment-resistant depression better than taking antidepressants independently."},{"tagName":"p","source":"According to the \u003ca href=\"https://www.apa.org/depression-guideline/guideline.pdf\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"content-link css-150s69f\"\u003eAmerican Psychological Association (APA)\u003c/a\u003e, most people experiencing treatment-resistant depression benefit from a combination of medication and psychotherapy."},{"tagName":"h3","source":"Cognitive behavioral therapy"},{"tagName":"p","source":"Cognitive behavioral therapy (CBT) is a form of psychotherapy that focuses on changing your mental and behavioral responses to stress."},{"tagName":"p","source":"CBT is powerful because it also helps you respond to factors that contribute to depression. It may help you change negative thought patterns and engage in meaningful activities or behaviors."},{"tagName":"p","source":"This type of therapy empowers you to act as your own therapist so you can continue helping yourself over the long term."},{"tagName":"p","source":"One study looked at the effects of combining CBT and antidepressant medications. Those who received both were more than \u003chl-trusted-source source=\"The Lancet\" rationale=\"Highly respected journal,Expert written journal,Peer reviewed journal\"\u003e\u003ca href=\"https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61552-9/fulltext\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"content-link css-150s69f\"\u003e3 times\u003c/a\u003e\u003c/hl-trusted-source\u003e as likely to show long-term improvements in depression symptoms as those who took just antidepressants."},{"tagName":"p","source":"Even if you stop taking medication for depression symptoms, the skills you learned in CBT continue to help you throughout life."}]},{"id":"brain-stimulation","title":"Brain stimulation","isCollapsable":false,"header":["Brain stimulation"],"body":[{"tagName":"p","source":"Doctors reserve brain stimulation procedures as a last resort for people who have not responded well to multiple antidepressants or therapy."},{"tagName":"p","source":"If you decide to try this treatment, a doctor will stimulate parts of your brain with electricity."},{"tagName":"p","source":"Electroconvulsive therapy (ECT) is the type of brain stimulation researchers have studied most. Healthcare professionals have used it since the early 1900s to treat mental health conditions."},{"tagName":"p","source":"Although portrayals of ECT in pop culture have often been negative, \u003chl-trusted-source source=\"PubMed Central\" rationale=\"Highly respected database from the National Institutes of Health\"\u003e\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6982454/\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"content-link css-150s69f\"\u003estudies\u003c/a\u003e\u003c/hl-trusted-source\u003e suggest that it can provide relief for many people who don’t respond to antidepressants."},{"tagName":"p","source":"ECT is also very safe in its modern form — an important point to consider if you’re wondering whether you should get it."},{"tagName":"p","source":"The \u003ca href=\"https://www.apa.org/depression-guideline/guideline.pdf\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"content-link css-150s69f\"\u003eAPA\u003c/a\u003e generally recommends that doctors reserve ECT for people experiencing severe treatment-resistant depression, such as those who are experiencing suicidal thoughts or also experiencing psychosis."},{"tagName":"p","source":"If ECT doesn’t work to resolve symptoms, your doctor may recommend trying other brain stimulation techniques, such as:"},{"tagName":"ul","source":"\u003cli\u003erepetitive transcranial magnetic stimulation (rTMS)\u003c/li\u003e\u003cli\u003evagus nerve stimulation (VNS)\u003c/li\u003e\u003cli\u003edeep brain stimulation\u003c/li\u003e"}]},{"id":"living-with-depression","title":"Living with depression","isCollapsable":false,"header":["Living with treatment-resistant depression"],"body":[{"tagName":"p","source":"There are many small steps you can take to help manage your symptoms of depression."},{"tagName":"h3","source":"Stick to your treatment plan"},{"tagName":"p","source":"Even if you feel better, it’s advisable to keep taking your medications as prescribed and continue going to therapy. Depression symptoms could return if you stop treatment."},{"tagName":"p","source":"If you have concerns about your medications, such as side effects that you don’t like, your psychiatrist may have other options."},{"tagName":"h3","source":"Stress management techniques"},{"tagName":"p","source":"Therapy can help you develop skills to cope with stress in a healthy, productive way."},{"tagName":"p","source":"It can also help you manage particular factors related to depression, such as negative thought patterns or lack of enjoyment or motivation."},{"tagName":"h3","source":"Self-care helps"},{"tagName":"p","source":"\u003ca href=\"https://academic.oup.com/nutritionreviews/advance-article/doi/10.1093/nutrit/nuaa118/6000409?login=true\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"content-link css-150s69f\"\u003eResearch\u003c/a\u003e suggests that people who eat a diet rich in fruits and vegetables are less likely to experience depression symptoms. It also recommends physical activity as a complement to antidepressant treatment."},{"tagName":"p","source":"If you drink alcohol, smoke, or take recreational drugs, consider quitting. This may reduce symptoms of depression."},{"tagName":"p","source":"If you feel you need support for a substance use disorder, your healthcare professional may help."},{"widget":{"widgetFormat":"widget-call-out","items":[{"isBullets":true,"list":true,"headerTitle":["Are you in a crisis or considering suicide?"],"content":[{"tagName":"p","source":"If you or someone you know is considering suicide or self-harm, help is available:"},{"tagName":"ul","source":"\u003cli\u003eText or call 988, or chat \u003ca href=\"http://988lifeline.org\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"content-link css-150s69f\"\u003e988lifeline.org\u003c/a\u003e.\u003c/li\u003e\u003cli\u003eText “HOME” to the \u003ca href=\"https://www.crisistextline.org/?gclid=EAIaIQobChMIsPDQrdXH5wIVBRx9Ch1YdQjIEAAYASAAEgJ_1_D_BwE\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"content-link css-150s69f\"\u003eCrisis Textline\u003c/a\u003e at 741741.\u003c/li\u003e\u003cli\u003eNot in the United States? Find a helpline in your country with \u003ca href=\"https://www.befrienders.org/\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"content-link css-150s69f\"\u003eBefrienders Worldwide\u003c/a\u003e.\u003c/li\u003e\u003cli\u003eIf it’s an emergency, call or visit your local emergency room or psychiatric care center to speak with a mental health professional.\u003c/li\u003e"}]}]},"brandPage":{}}]},{"id":"recap","title":"Recap","isCollapsable":false,"header":["Recap"],"body":[{"tagName":"p","source":"If you’re experiencing treatment-resistant depression, you may feel frustrated and disheartened, but there is hope."},{"tagName":"p","source":"Changing your antidepressant medication and getting counseling or therapy may help ease your symptoms."},{"tagName":"p","source":"If you’ve tried multiple kinds of medications and your depression symptoms are still affecting your life, your healthcare professional may have other treatments available."}]}],"hasAffiliateLinks":false,"affiliates":[],"propsFor":{"articleResources":[{"displayLink":"ncbi.nlm.nih.gov/pmc/articles/PMC7730956/","link":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7730956/","title":{"tagName":"span","source":"Alshammari TK. (2020). The ketamine antidepressant story: New insights."}},{"displayLink":"bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-019-2237-x","link":"https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-019-2237-x","title":{"tagName":"span","source":"Bennabi D, et al. (2019). Clinical guidelines for the management of treatment-resistant depression: French recommendations from experts, the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental."}},{"displayLink":"apa.org/ed/graduate/specialize/counseling","link":"https://www.apa.org/ed/graduate/specialize/counseling","title":{"tagName":"span","source":"Counseling psychology. (2008)."}},{"displayLink":"apa.org/depression-guideline/guideline.pdf","link":"https://www.apa.org/depression-guideline/guideline.pdf","title":{"tagName":"span","source":"Clinical practice guideline for the treatment of depression across three age cohorts. (2019)."}},{"displayLink":"pubmed.ncbi.nlm.nih.gov/33706168/","link":"https://pubmed.ncbi.nlm.nih.gov/33706168/","title":{"tagName":"span","source":"Di Vincenzo JD, et al. (2021). The effectiveness, safety and tolerability of ketamine for depression in adolescents and older adults: A systematic review."}},{"displayLink":"nimh.nih.gov/about/director/messages/2019/new-hope-for-treatment-resistant-depression-guessing-right-on-ketamine.shtml","link":"https://www.nimh.nih.gov/about/director/messages/2019/new-hope-for-treatment-resistant-depression-guessing-right-on-ketamine.shtml","title":{"tagName":"span","source":"Gordon J. (2019). New hope for treatment-resistant depression: Guessing right on ketamine."}},{"displayLink":"ncbi.nlm.nih.gov/pmc/articles/PMC6494651/","link":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6494651/","title":{"tagName":"span","source":"Ijaz S, et al. (2018). Psychological therapies for treatment\u0026#8208;resistant depression in adults."}},{"displayLink":"sciencedirect.com/science/article/abs/pii/S0165032720327026","link":"https://www.sciencedirect.com/science/article/abs/pii/S0165032720327026?via%3Dihub","title":{"tagName":"span","source":"Marcantoni WS, et al. (2020). A systematic review and meta-analysis of the efficacy of intravenous ketamine infusion for treatment resistant depression: January 2009 \u0026ndash; January 2019."}},{"displayLink":"sciencedirect.com/science/article/abs/pii/S0924977X19302597","link":"https://www.sciencedirect.com/science/article/abs/pii/S0924977X19302597?via%3Dihub","title":{"tagName":"span","source":"Perugi G, et al. (2019). 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