Treatment Resistant Depression – What is it?

Treatment resistant depression is a term used in psychiatry to describe patients with depression who do not feel fully well after 2 courses of treatment with antidepressants. This is a true mind body illness, such that untreated depression is known to affect both the brain and other organ systems of the body. TRD is quite common with more than 50 percent of cases not fully responding to medications, therapy, and exercise. Contributing factors may include comorbid psychiatric or medical conditions. Strategies to treat TRD include increasing medication dosages, switching medications, and augmenting with other medications. Other strategies to treat TRD include psychotherapy, ECT, VNS, and a promising new non-invasive technique called rTMS. We offer this latest technique as part of our practice and are happy to discuss the option of this treatment with you.


It is a common belief that depressive illnesses result from chemical imbalances in the brain. While this is certainly a part of the equation, it does not accurately capture the complexity of the illness. In addition to chemical imbalances, it is now believed that depression can be caused by a combination of biological, environmental, genetic, and psychological factors. As such, it is often best treated by variety of interventions including medications, psychotherapy, exercise, and new treatments including rTMS.

 Signs & Symptoms

Each person is a unique individual and those with depressive illnesses do not all experience the same symptoms. The following is a list of the most common symptoms reported by those suffering from a depressive illness. The severity, frequency, and duration of symptoms vary depending on the individual and his or her particular illness.

Signs and symptoms include:

  • Persistent sad, anxious, or “empty” feelings
  • Feelings of hopelessness or pessimism
  • Feelings of guilt, worthlessness, or helplessness
  • Irritability, restlessness
  • depression-persistentLoss of interest in activities or hobbies once pleasurable, including sex
  • Fatigue and decreased energy
  • Difficulty concentrating, remembering details, and making decisions
  • Insomnia, early-morning wakefulness, or excessive sleeping
  • Overeating, or appetite loss
  • Thoughts of suicide, suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems that do not ease with treatment.