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Treatment Resistant Depression

© Sharon L. Cohen

Beth is depressed. Clinically depressed and depressed about being depressed. She's one of millions of people who have not responded to the magic of antidepressants. She's been there and back for Prozac, Effexor, Wellbutrin, Parnate, Lithium...you name it. Beth is not alone. According to an article in US News and World Report, by 2020 depression will be in second place-after heart problems-for disabling diseases. Already the World Health Organization puts the disease in first place for women and fourth place overall.

In the US, depression strikes 18 million people at any one time. And many of these people are helped by antidepressants. But, says the article, 30 percent of these people do not respond to this medication and 70 percent who do respond do so only partially or for only a certain length of time. Yes, the antidepressants have helped a considerable number of people. However, it's not the fountain of youth for everyone. Nearly six million people continue to suffer for indefinite periods of time.

Likewise reports American Family Physician magazine, partial response and nonresponse to antidepressant medications are common problems in patients with depression. This publication puts the number between 10 and 30 percent of depressed patients who are taking an antidepressant and are partially or totally resistant to the treatment. Recurrence of depression while still taking medication (i.e., breakthrough) can also occur.

Why are some people not helped by the medication? The article notes several reasons: Treatment failure, including undiagnosed or misdiagnosed medical conditions such as hypothyroidism and anemia. This would indicate that a person who does not respond should be reevaluated by a physician to ensure the initial diagnosis of depression was correct. Another reason medication doesn't work is that nonpsychiatric drugs such as methyldopa (Aldomet), beta blockers and reserpine (Serpasil) can cause or exacerbate depression. Finally, adverse effects and poor compliance may be additional obstacles to successful treatment. Side effects can be too severe to either stay on the medicine or go up to a high enough level to be advantageous.

Even the term "depression" causes a problem. People wrongly associate the word with despondency and ignore the illness or treat it too lightly. National Institute of Mental Health neuroscientist Philip Gold says (as reported in US News and World Report) "People confuse it with the everyday sensation of feeling despondent and dismiss it. In fact, it takes an incredibly strong person to bear the burden of the disease, which ought to be given a more appropriate name."