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Treatment for Refractory Depression

Dealing with refractory depression can be incredibly tough. Refractory depression is major depression disorder that doesn't respond to at least two different types of antidepressent medication. Refractory depression is different from dysthemia, which is a persistent low mood that doesn't impact daily functioning. It might seem as if there's no help for the condition, but taking the time to try--and stick with--different medications and types of therapy can pay off in the end with better moods and functioning.

  1. Medications

    • Even if antidepressants haven't worked for you in the past, there are a variety of different antidepressants to try and also ways to combine these and other drugs for better effects. Different types of antidepressants affect the levels of the three major neurotransmitters--dopamine, norepinephrine, and serotonin--in your brain. Non-antidepressant medication can also help heighten the effects of antidepressants by boosting neurotransmitter levels or absorption. Keeping strictly to your prescribed regimen of antidepressants makes sure that the antidepressants you are already taking have the best effect possible.

    Genetic Testing

    • Your body may react differently to different antidepressants, depending on your genetic makeup.The cytochrome P450 (CYP450) genetic test can measure how well your body can metabolize drugs, including antidepressant medications. This test may help you pick an antidepressant that works the best with your body type, and what dosage of that drug you will need. Be aware that the CYP450 test isn't comprehensive and can be costly, as it isn't covered by insurance. There are also tests available to check your body's response to the neurotransmitter serotonin.

    Psychotherapy

    • Therapy may not have worked out for you in the past--you may have had a poor relationship with your therapist or felt that since a certain type of therapy didn't help your situation, all therapy is useless. However, there are several different types of therapy, with some therapists specializing in treating patients with refractory depression. Look into different types of short-term and long-term psychotherapy, and make sure that you work with a therapist whom you trust.

    Other Conditions

    • Sometimes what seems like depression is actually another mood disorder. For example, bipolar disorder can be misdiagnosed as depression if manic or "up" episodes are infrequent or are tempered by depressive tendencies. Physical conditions such as thyroid disorders, chronic pain, heart problems and anemia can also worsen depression. Treating these physical problems can better your mental state. Don't discount life circumstances, either. If there is something bothering you in your outside life, such as poor finances or dissatisfaction with some aspect of your family or work life, working to fix the problem can help fix your mood.

    Other Treatments

    • There are non-medication treatments for severe depression. Modern electroconvulsive therapy (ECT) is an effective way of easing severe depression--because it works so quickly, it is a good choice for people who are at high risk of harming themselves without immediate intervention. Other experimental methods of treatment are available for refractory depression. These treatments rely on stimulating the brain or nervous system and include vagus nerve stimulation, transcranial magnetic stimulation, and deep brain stimulation.

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