Understanding Treatment-Resistant Depression

Depression is one of the most common mental health conditions, and for many people, therapy, lifestyle changes, or medication can provide significant relief. But for some, the symptoms of depression linger or return even after trying multiple treatments. This is often referred to as treatment-resistant depression (TRD). Understanding what it means and what options exist can offer hope for those who feel stuck.

What is treatment-resistant depression?

Treatment-resistant depression is typically diagnosed when a person does not improve after trying at least two different types of antidepressant medications at adequate doses and durations. But TRD is not just about medication; it can also describe depression that does not fully respond to therapy or other common interventions.

Signs you may be dealing with TRD

• Ongoing feelings of sadness, emptiness, or hopelessness despite treatment

• Lack of energy or motivation that interferes with daily life

• Difficulty finding joy in activities you once enjoyed

• Sleep or appetite problems that continue even with support

• Feeling discouraged by repeated attempts at treatment that have not worked

Why does treatment resistance happen?

Depression is complex, and no single factor explains why some people struggle to find relief. Genetics, co-occurring conditions (like anxiety, ADHD, or PTSD), medical issues, or even unresolved trauma can all play a role. Sometimes what appears to be TRD is actually a sign that the diagnosis needs to be reevaluated through psychological testing or a more comprehensive assessment.

Treatment options for TRD

The good news is that there are still effective options for those dealing with treatment-resistant depression. These may include:

• Different therapy approaches such as cognitive-behavioral therapy (CBT), acceptance and commitment therapy (ACT), or trauma-focused therapy.

• Combination treatments that integrate therapy with medication management.

• Lifestyle interventions like structured exercise, sleep regulation, or mindfulness practices.

• Specialized treatments such as transcranial magnetic stimulation (TMS) or other advanced interventions offered by some providers.

The role of therapy

Even if past treatments have not fully worked, therapy remains an essential part of recovery. Individual counseling provides a safe space to explore underlying issues, develop coping skills, and prevent hopelessness from taking over. Therapy can also help manage the frustration that comes with treatment resistance and keep you connected to the process of healing.

Finding hope in the process

Living with treatment-resistant depression can feel discouraging, but it does not mean recovery is impossible. With the right combination of approaches and ongoing support, many people do improve and regain quality of life.

At Etheridge Psychology, we provide depression therapy in Cary, NC, for adults, teens, and children. We can also conduct psychological testing to determine if there are other mental health explanations for some of your symptoms. Our therapists work with clients facing complex or treatment-resistant depression to find new strategies for relief and healing.