7 Reasons why your depression may not be getting better



Although there has been tremendous progress in the treatment of depression, many patients do not achieve a full response to treatment.  An estimated 32 to 35 million adults in the United States experience an episode of major depression during their lifetime.  When depressed patients present for treatment, the results can often be less than satisfactory.   In fact, some studies indicate that only about 1/3 of depressed patients who receive treatment, achieve full remission.

Therefore, the goal when treating depression is not to just improve somewhat but to get all the way better.  Why does the management of treatment-resistant depression (TRD) remain a complex clinical problem for a large population of patients and their clinicians?  There are several important factors to take into consideration when pursuing a full response to treatment.

  1. Early intervention is important.  The longer a patient remains depressed before treatment, the lower the chance of full recovery.
  2. Many patients are treated with inadequate dosages and for too short of a duration of time (less than 6 weeks)
  3. Lack of adherence to the medication recommendation or intolerable side effects.
  4. Patients may be on the wrong medication.
  5. Some patients may require a combination approach with medication instead of just one medicine.
  6. Combining psychotherapy with medication management for best outcomes.
  7. There may be undiagnosed co-occurring disorders that complicate the treatment (Anxiety, ADHD, Eating Disorder and trauma).

Patients may have a genetic subtype of depression that responds less well to current treatments.

With all of these clinical factors it is very important to work closely with your psychiatrist and psychotherapist.  One reason this is important is because any response short of remission is associated with functional impairment and an increased risk of relapse.  Modifying the treatment when necessary increases the chances of a full recovery and improving quality of life.

With advances in neuroscience we will be able to better understand the mechanism of action of antidepressants and psychotherapy.  This knowledge will help guide clinicians as they recommend treatment approaches.  In addition, new treatment options that do not require medication are available. Transcranial Magnetic Stimulation  (TMS) is a FDA-approved non-systemic  and non-invasive treatment for Major Depression.

Also, improved methods of classifying patients will be developed to increase the success rates of treatments. For example, an individuated treatment approach would use the results from genetic analysis, brain imaging, electroencephalography and other testing methods to predict patients’ response to specific antidepressant agents.