What can be done for treatment-resistant depression?

Treatment-resistant depression is defined as the failure of three or more antidepressants to control depression. This is common. One out of three people trying antidepressants find they don’t work.

I find that about one third of the time it is because people are not applying what they are learning in counseling. They know how to meditate to calm their mind, but they are not doing it. They know how to stop overthinking, but they dont use the techniques. They know walking an hour per day boosts their mood, but they don’t do it.

For two out of three people, they need a different kind of antidepressant. Some need a much higher dose of an antidepressant, such as 300 to 400 mg of sertraline. I have one patient like that. Some need psychological testing. One patient found her additional “antidepressant” was psychological testing that showed she had personality traits that made it hard to her to understand people, and hard for other people to understand her.

Other options are many. I have several patients who got good results with Ketamine therapy, whether by IV or subcutaneous (a shot just under the skin). I will be providing subcutaneous shots of ketamine in my office, starting in 2024.