Major depressive disorder (MDD) affects 4.1% of the Australian population, and 13.6% of those people are likely to have treatment resistant depression. If you’ve been struggling with depression symptoms that don’t improve with standard treatments, you might be experiencing TRD.
Before you make any decisions on the way forward, this guide will help you understand TRD, its causes, and the available comprehensive treatments for depression.
Contact Neuralia TMS if you need any more information or want to experience the life-changing effects of transcranial magnetic stimulation for treatment-resistant depression in adults.
Key Takeaways
- TRD is a form of depression that persists despite trying at least two antidepressants for 6 to 8 weeks, with symptoms like persistent sadness, fatigue, and suicidal thoughts often being more severe and recurring.
- TRD develops from a mix of biological issues (e.g., neurotransmitter imbalances), psychological challenges (e.g., unresolved trauma), and environmental stressors (e.g., chronic stress or substance abuse).
- A thorough evaluation, including mental health assessments, medical tests, and treatment history reviews, is critical for diagnosing TRD correctly.
- Regular exercise, a nutritious diet, quality sleep, and stress management can boost the effectiveness of TRD treatments and improve mental well-being.
What is Treatment-Resistant Depression?
Treatment-resistant depression (TRD) refers to a form of depression that doesn’t improve after trying at least two different antidepressant treatments at the right doses for a minimum of 6 to 8 weeks. People with TRD may continue to experience persistent symptoms despite various types of treatments being attempted.
Do I Have Treatment-Resistant Depression?
You may have TRD if you have a number of depressive symptoms that haven’t improved despite at least two rounds of treatment with different antidepressants.
Symptoms of Treatment-Resistant Depression
People with treatment-resistant depression may show the same symptoms as those with major depressive disorder, including:
- Persistent Depressed Mood: A continuous feeling of sadness or emptiness
- Loss of Interest: Diminished pleasure in activities you once enjoyed
- Sleep Disturbances: These could be either insomnia or excessive sleeping
- Fatigue: You may experience persistent tiredness or lack of energy
- Appetite Changes: A lack of enjoyment in your favourite foods or drinks
- Weight Changes: Unexplained and unrelated to dieting
- Difficulty Concentrating: Trouble focusing or making decisions
- Feelings of Worthlessness: Excessive guilt or self-blame
- Suicidal Thoughts: Recurrent thoughts of death or suicide
For patients with treatment-resistant depression, these symptoms are more severe and may last longer than in other depression cases. These symptoms may ease up on occasion, but they tend to return more severely than before in patients with TRD.
How is TRD Diagnosed?
Diagnosing treatment-resistant depression generally involves a professional evaluation, a physical exam, and various medical tests such as blood tests. Doctors take a thorough and systematic approach to make sure TRD is accurately identified and managed. In Australia, this process typically includes:
1. Professional Evaluation
A psychiatrist will perform a detailed evaluation of the patient’s mental health history, current symptoms, and overall functioning. Tools like the Patient Health Questionnaire-9 (PHQ-9) and the Kessler Psychological Distress Scale (K10) help psychiatrists quantify the symptoms’ severity.
This stage will also include a review of treatment history (including medication, dosages, durations, and responses), screening for underlying psychiatric conditions that may be influencing your response to treatment, and an evaluation of suicide risk.
2. Medical Workup
This stage includes a physical exam and necessary lab tests to identify any medical conditions that could affect depression or its treatment. It also includes testing thyroid levels, because thyroid imbalances can mimic depressive symptoms.
If you’re being evaluated for TRD, you’ll also be screened for alcohol or drug use that could be contributing to your symptoms. Pharmacogenetic testing will also be done here to understand how genetic factors might be influencing the way you respond to medication.
3. Final Diagnosis
The final diagnosis is given after the psychiatrist has confirmed no improvement after the patient has tried at least two different antidepressant medications, taken at the correct doses for a minimum of 6 to 8 weeks. The psychiatrist will also rule out other medical or psychiatric disorders that could influence depression.
What Causes Treatment-Resistant Depression?
The factors contributing to TRD are multifaceted and can be categorised into biological, psychological, and environmental causes. Understanding the underlying causes of TRD helps select effective treatment strategies.
| Factors | Details |
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| Biological Factors |
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| Psychological Factors |
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| Environmental Factors |
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How is Treatment-Resistant Depression Treated?
TRD is usually treated with one or a combination of the following types of treatment: brain stimulation, medication, and psychotherapy. Each treatment option works best when also combined with lifestyle changes to encourage mental health.
Non-Invasive Brain Stimulation
| Treatment Option | Advantages | Disadvantages |
|---|---|---|
| Repetitive Transcranial Magnetic Stimulation (rTMS) |
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| Magnetic Seizure Therapy (MST) |
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| Electroconvulsive Therapy (ECT) |
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Invasive Neuromodulation Techniques
| Treatment Option | Advantages | Disadvantages |
|---|---|---|
| Deep Brain Stimulation (DBS) |
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| Vagus Nerve Stimulation (VNS) |
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Medication and Psychotherapy
| Treatment Option | Advantages | Disadvantages |
|---|---|---|
| Medication Strategies |
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| Psychotherapy Options |
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Managing Lifestyle
For treatment to be most effective, you should make lifestyle changes to support whatever treatment you’re going through. This includes:
Substance Use
Alcohol, nicotine, recreational drugs, and prescription drugs can interfere with antidepressant medications. Patients should limit their intake as much as possible to increase the chances of successful treatment.
Sleep Optimisation
The brain and body heal during sleep. Maximise your sleep by maintaining a consistent sleep and waking time, optimising your sleep environment (temperature, darkness, etc.), and avoiding screen time for at least an hour before bed. Track sleep quality if possible so you can monitor the effect it’s having.
Exercising Regularly
Working out releases endorphins and can improve mood, cognitive abilities, and overall mental health. Find something you enjoy doing and start gradually, just a small bit every day until you get into good habits.
Dietary Changes
Eating foods rich in omega-3 fatty acids can benefit brain health. Fruits and vegetables are loaded with antioxidants, which can positively affect your body and mind. Avoid processed foods as much as possible, as they cause inflammation and can make major depressive disorder worse.
Reducing Stress
Implementing practices like meditation, deep breathing, and progressive muscle relaxation can lower stress and reduce symptoms. Journaling is also an excellent way to process complex emotions and identify emotional patterns.
Let Us Help You Get Your Life Back
Science backs TMS as an effective drug-free option for treatment-resistant depression. Visit your nearest Neuralia TMS clinic today and let us help you find your peace and joy again.
FAQs on Do I Have Treatment Resistant Depression?
Is TMS treatment for TRD covered by insurance?
Yes, TMS treatment for TRD is covered by Medicare in Australia. The cost of TMS treatment, including standard TMS sessions and psychiatrist reviews, is fully covered with no out-of-pocket fees for depression patients, which makes the TMS therapy cost effectively $0 at Neuralia TMS. See our TMS cost breakdown for more info.
A few other treatments for treatment resistant depression are covered under Medicare or private health insurance in Australia. Coverage may include consultations with psychiatrists, psychological therapies (e.g., cognitive behavioural therapy or CBT), and medications. Advanced treatments like electroconvulsive therapy (ECT) may be covered in hospital settings with private health insurance.
Are brain stimulation techniques safe?
Brain stimulation techniques, such as TMS and ECT, are generally considered safe when performed by qualified professionals. While mild side effects are sometimes reported, serious complications are rare. Moreover, both TMS and ECT have been extensively studied and approved for specific mental health conditions, including TRD. Always consult with a healthcare provider to discuss potential risks and benefits.
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