Factsheet: Dealing With Treatment-Resistant Depression: What to Do When Treatment Doesn't Seem to WorkEveryone gets down from time to time, but feelings of sadness that last two or more weeks may be a sign of clinical depression. It is a real and serious health condition that affects more than 20 million American adults each year. 
These are signs and symptoms of depression:
Can depression be treated?
Depression is highly treatable with treatments such as therapy, medicine, and lifestyle changes. But it may not always be easily treated. For many people, depression may continue despite treatment. They may have treatment- resistant depression or TRD. This happens when medicine partly relieves their symptoms or does not help at all.
How is TRD treated?
If treatment hasn’t yet worked for you, do not give up! Try to stay hopeful that you will get well and even recover. Consider these options and talk to your doctor about which treatments may be right for you.
Vagus Nerve Stimulation (VNS) is one type of neurostimulation that has been approved as an additional treatment for long-term or recurrent depression in adults who have not had success with four or more antidepressant medicines. A device is put into the chest and sends an electrical current to the brain.
Electroconvulsive Therapy (ECT) is another type of neurostimulation. ECT can be helpful for people whose depression is severe or life-threatening and for people who cannot take antidepressant medicine. Electrodes are placed on the head to deliver electrical impulses. ECT has been controversial, but has improved in recent years. It can help when antidepressant medicines do not work well enough. Researchers are also looking at other neurostimulation treatments, such as transcranial magnetic stimulation (TMS), magnetic stimulation therapy (MST), and deep brain stimulation (DBS).
Researchers at the National Institute of Mental Health, part of the National Institutes of Health, are looking at the effectiveness of different treatments for people who still have symptoms from depression after they have already tried an antidepressant. The study has multiple phases. So far, they have released these results:
The study shows that people who have tried antidepressants, but still have symptoms from depression, have a variety of medication options. For more information, visit http://www.nimh.nih.gov/healthinformation/stard.cfm.
For many weeks, I felt tired but couldn’t sleep. I didn’t feel like eating and felt sad all of the time. I stopped seeing friends and hopeless about my life. I knew something was wrong and talked to my doctor, who gave me a prescription for an antidepressant and suggested counseling. I started taking medicine and was in counseling, but after four months, I still didn’t feel a lot better. But I continued to work with my doctors, and as a team, we found a medicine that helped me. Gradually, I began to feel better. It was a long process, but with help, I was able to get through it.
National Institute of Mental Health
Phone: (866) 615-6464
Depression and Bipolar Support Alliance
Phone: (800) 826-3632
Families for Depression Awareness
Phone: (781) 890-0220
This information is being provided through an educational (unrestricted) grant from Cyberonics, Inc.
 Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun; 62 (6): 617-27.
 Frank E, Karp JF, Rush AJ (1993). Efficacy of treatments for major depression. Psychopharmacology Bulletin, 1993; 29:457-75.
 National Institute of Mental Health: http://www.nimh.nih.gov/healthinformation/stard_qa_level1.cfm.
 National Institute of Mental Health: http://www.nimh.nih.gov/healthinformation/stard_qa_level2.cfm.
 National Institute of Mental Health: http://www.nimh.nih.gov/press/stard3.cfm
For More Information:For help finding treatment, support groups, medication information, help paying for your medications, your local Mental Health America affiliate, and other mental health-related services in your community, please contact us.
If you or someone you know is in crisis now, seek help immediately. Call 1-800-273-TALK (8255) to reach a 24 hour crisis center or dial 911 for immediate assistance.
Page last updated: 3/6/2009