What Does Treatment-Resistant Really Mean?


healthtap.comIn his book “Economic Warfare: Secrets of Wealth Creation in the Age of Welfare Politics,” author Ziad K. Abdelnour writes, “One of the hardest decisions you’ll ever face in life is choosing whether to walk away or try harder.”

I face that decision every day.

Twenty times a day.

Several times an hour.

That one line contains the kernel of so much of my struggle, which is why I pray the Serenity Prayer every five minutes or so:

God, grant me the serenity to accept the things I cannot change,

The courage to change the things I can,

And the wisdom to know the difference.

We have this conversation often on Group Beyond Blue, the online forum I moderate. Someone asked the other day, “How do you know the difference between being treatment resistant and just not trying hard enough?”

The short answer is that you don’t.

As I explained in my post, “Do You Want To Be Depressed?” I question it all the time. If I only run five miles instead of six, I beat myself up and feel responsible for my death thoughts. If I splurge on a muffin for breakfast instead of making my kale smoothie, the self-flagellation can last all day.

I have only labeled myself “treatment resistant” in the last six months, when I got up to medication combination number #50 and was still counting down the years until I could die a natural death and envying folks in their 90s. Someone in the group asked, “How did you decide that #50 was going to be the best result that medication could give you. I mean, why not try #51?”

“I don’t really know,” I told him. “I guess I just fed up with the pharmaceutical Russian roulette.”

I saw the pharmacists at Sam’s Club more often than my friends. I fully expected them to throw me a surprise birthday party last February since my date of birth was at the tip of their tongues.

It was simple statistics. Over the course of nine years, I’ve tried 50 meds, been in therapy much of that time, and had enjoyed only two real solid years of remission.

Pretty pathetic results.


So I immersed myself in the holistic world: took mindfulness courses, significantly altered my diet, loaded up on fish oil and other supplements, and researched an endocrinologist that would actually test my T3 and T4 levels and work with me to resolve my thyroid and pituitary issues.

Since the beginning of the year, I’ve just stayed on the medication combination that worked back in 2006, when I experienced a remission of symptoms for two years. Even though I was still severely depressed in January, I didn’t want to muck around anymore.

“How long does a depressive episode last without treatment?” I asked my psychiatrist last winter.

“It depends. Possible two years or more.”

“So my last depression in 2005 lasted about two years. How do I know it was combination #23 that brought me out of it or if I just surfaced on my own?”

“You don’t,” she said.

Back to the Serenity Prayer.

Back to feeling your way blindfolded through an enchanted forest, a place of threatening danger with booby taps and evil spirits, or—if I’m feeling more optimistic–a kind of adventure that make brave people braver.

“Treatment resistant” is a broad term that can be confusing. According to Wikipedia, it is a term “to describe cases of major depressive disorder that do not respond to adequate courses of at least TWO antidepressants.”

At standard doses of the most commonly used class of antidepressants (SSRIs), only 30 percent of people with severe depression achieve remission with the first medication prescribed. STAR*D, a government-sponsored, six-year study found that if a patient can hang in there for at least two different drug treatments, which often takes 12 weeks to achieve, there is a better than 50 percent chance he or she will experience a remission of symptoms.

I interviewed a psychiatrist last week who treats many of her patients successfully with transcranial magnetic stimulation (TMS), a non-invasive procedure that stimulates nerve cells in the brain with short magnetic pulses.

“What do you consider to be treatment resistant?” I asked her.

“When someone hasn’t responded to a full trial of one antidepressant,” she said.

“ONE?!!?” I almost spit out my water. “ONE antidepressant??”

National Alliance on Mental Illness (NAMI), America’s largest mental health organization, defined it the same way: “Treatment resistant depression (TRD) is the clinical term for an episode of major depressive disorder that does not respond to an adequate trial (at least six weeks) of an antidepressant medication.”

That means everyone I know is treatment resistant.

For the record, I am not anti-med. Not in the slightest. I believe that antidepressants save the lives of millions of people, some of them my dear friends and family members. At one point in my life, they worked well for me. However, I’m becoming increasingly aware that they don’t work as the SOLE treatment for MOST people. There just is no silver bullet when it comes to treating mood disorders. And the more I discuss my own treatment-resistant depression in public forums, the more stories I hear of others not responding to medication or having a half-response like me.

The reason I need my group is that it provides proof that you can live a very full and meaningful life with the type of depression that doesn’t respond or respond fully to meds. I see hundreds of people doing just that.

It’s work.

Oh man, it’s work.

It takes persistence, stamina, resolve, discipline, fortitude, and humility—the ability to be a forever learner.

But based on the beautiful examples I see online, being treatment resistant doesn’t have to mean being chronically sick.

It’s more like being chronically creative.

And it doesn’t really matter if you walk away or try one more drug.

Originally published on Sanity Break.

Image: healthtap.com

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Therese Borchard
I am a writer and chaplain trying to live a simple life in Annapolis, Maryland.

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7 Responses
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  2. DEE

    In May, 2014 I started TMS. I did the initial 30 treatments in six weeks. I felt slightly better for a few months, however soon after went back to my normal depressive state. I have had an additional 20 treatments since since I finished the initial treatment. I have reluctantly let myself get knocked upside the head by the TMS machine for 37 minutes each time and it has proven to be as ineffective as the 40 plus drugs I have tried over the past 20 years. My psychiatrist added meds in September 2014 saying it will help in

    conjuction with the TMS. Basicly I am still depressed. No skipp

    ing or smily faces here. I see psychiatrist as legal drug
    dealers. She had the nerve to call it an art…I should have said yes..perhaps abstract art!

  3. S stewart

    Mrs.borchard:I deeply sympathize with you.I have resistant treatment depression also.My story is similar to yours.Medication after medication with very little change in my depression.I asked my doctor if I could try a stimulant with lexapro and it was a godsend for me.if you have not tried this you may want to give it a go.it worked wonders for me and is safe.If you have tried it and it did not work I am sorry.It gave me my life back.If you would like to ask me specifics,I would be more than willing to discuss my treatment.. Thank you for your honesty. s stewart

  4. Jennifer mackinnon

    A lot of good stuff here. You really get it! I’m suffering quite a bit at this time e in my life, still trying but it’s hard to have hope after all that i’ve tried…. medication, therapy, ect… i’ve had it all but am trying to keep going. It’s the worst disease