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Treatment Resistant Depression

treatment resistant depression

What is Treatment Resistant Depression?

Treatment resistant depression (TRD) is a form of depression that has not responded to treatment with at least two antidepressants. TRD can impact your mental and physical health and your ability to hold a job and function in everyday life. 

In the United States, the estimated annual prevalence of medication-treated MDD was 8.9 million adults, and 2.8 million (30.9%) had TRD. As you can see, you are not alone with your treatment resistant depression. 

Most people coping with any type of major depressive disorder use antidepressant medication as their first line of treatment. Unfortunately, for people with TRD, standard medications may not provide adequate relief.

For people with TRD, identifying the right treatment can take longer than for others. Some people may find that traditional medications work initially, but then stop working altogether. This is where integrative psychiatry can benefit people suffering from treatment resistant depression as we can tailor a hollistic plan that goes beyond antidepressants to give you the relief you need.

What are the symptoms of treatment resistant depression?

Up to one-third of adults with major depression experience symptoms that don’t improve with treatment. However, that doesn’t mean you should give up! 

Unfortunately, there is no universally accepted definition of TRD within the medical community. While some experts define it as depression that hasn’t responded to two different antidepressants, others describe it as depression that doesn’t respond to four or more different types of treatment. 

In all cases, the most obvious symptom of treatment-resistant depression is that you see no signs of remission even after trying multiple antidepressant medications. 

The best way to know if you may have TRD is to pay attention to the following details about your experience with depression.

  • Do you see a lack of response to antidepressants and psychotherapy treatments?
  • Are you experiencing increasingly severe episodes of depression?
  • Do you see brief improvements followed by a return of depression symptoms?
  • Are you suffering from high anxiety or anxiety disorder?

How is treatment resistant depression identified?

Many patients come to Axis Integrated Mental Health not realizing that their medications are not giving them the quality of life they need and deserve. When people are used to antidepressants failing, it's easy to think that this is "just how it is" and expecting to feel differently is unrealistic. This is further exacerbated by a medical system that is overly reliant on overwhelmed primary care doctors who prescribe 79% of the antidepressants in the United States, but have very little time to follow-up on the complexities of psychiatric conditions.

We identify treatment resistant depression through a thorough 60-minute intake process. You will be asked about your health history, what events have affected you, and what your goals are for wellness. Follow-up appointments are 30-minutes at a minimum and we will discuss in-depth how you are feeling and what additional measures you can take with your lifestyle, nutrition, and alternative treatment options that can support your mental health goals.

It is vital to follow your medication schedule as per instructions to ensure the best possible chance for relief from your symptoms. This is because it is very easy for major depression to be misdiagnosed as TRD if patients do not follow dosage guidelines as instructed by their doctors.

Whether you’re on vacation or frustrated by a lack of response after a few weeks, stay on course with your medication. Do not make changes to your medication schedule without consulting your doctor.

It is also good to know that it can take four to eight weeks to see the full effects of an antidepressant, and even then, the dosage may need some adjustment depending on how well your symptoms respond. 

To determine if your depression is treatment-resistant, your therapist or psychiatrist may ask questions such as:

  • What medications for depression have you already tried?
  • Have you been taking your medications?
  • Have you been taking any other medications?
  • Have you experienced any side-effects from taking the medication?
  • Do you have any other medical conditions impacting your depression?
  • Have there been any recent changes to your routine or environment?
  • Are there any new stressors in your life?

These questions can help your doctor identify if the resistance to treatment is biochemical, linked to another condition, or related to your environment. This information is a vital part of our team's strategy to design your treatment plan.


What will insurance cover for treatment resistant depression treatment?

Most insurance plans will cover your initial intake, follow-up appointments, and any prescribed medications like antidepressants. Treatment resistant depression criteria to establish eligibility for alternative treatment options however, can vary. While some insurance plans will cover additional treatment options like Spravato and TMS after 2 failed antidepressants, other insurance companies will only cover those treatment options after 4 failed antidepressants.

We are in-network with most major insurance plans and can advise you on what treatments each individual plan will cover, and advocate on your behalf to get you the best care possible at the lowest possible cost. We also have payment plan options for patients who wish to pay for treatments out-of-pocket without going through insurance.

Who is at risk for treatment resistant depression?

People more susceptible to TRD may have one of the following characteristics. 

  • Biological and psychological factors tend to make women more susceptible to TRD than men. 
  • Older people are likely to be at higher risk of TRD than younger people. 
  • People with underlying conditions, such as an eating disorder, sleep disorder, or substance abuse issue, may become resistant to certain antidepressants.
  • Some medical conditions, such as chronic pain and thyroid disease, may be associated with a higher rate of TRD.
  • Early onset of depression can increase the risk of developing TRD. 
  • People who experience frequent, recurring, or lengthy episodes of depression may be at higher risk for TRD.

Is Treatment Resistant Depression Hopeless?

TRD is not hopeless. We have seen many patients improve dramatically using some of the newer techniques for managing treatment resistant depression, with some patients reducing their need for medication entirely.  When the first line of treatment with antidepressants does not show desired results in treating your depression symptoms, we will not give up on you.  

Our patients have responded well to  TMS for treatment resistant depression, and rapid-acting medications like ketamine infusions and esketamine (Spravato).

Do not lose hope if a previously-tried treatment option didn’t work. It just means that you haven’t yet found the right treatment option for your unique circumstances. It may require a combination of treatments and lifestyle changes, such as managing stress, improving sleep habits, and engaging in regular exercise, to positively impact your depression. We believe that every person is unique and deserves a treatment plan customized to meet them where they are.   

Our team at Axis Integrated Mental health will work with you to develop a treatment plan that is right for you and work to refine it to your specific response to it. Your treatment plan can have any of the following options or a combination to suit your needs best. And you can be assured that no matter how long it takes to achieve your goals, we will be with you every step of the way.


With treatment resistant depression, it is important to consider all options. Most patients do not respond well to the first set of antidepressant medications. The key is to find the right medication and dosage. 

  • Trying other antidepressants
  • Trying two different classes of antidepressants at the same time
  • Adding a medication that may not medically be identified as an antidepressant but has antidepressant effects
  • Adjusting dosage

Psychotherapy or Talk Therapy

A wide range of different psychotherapy options can be used to treat depression. Talk therapy sessions can also be carried out in conjunction with the use of medication. 

Psychotherapy offers many different delivery methods, including Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), and interpersonal psychotherapy.

Finding the right psychotherapy approach for you may take a few tries.

Alternative Therapies

The list of treatment options for treatment resistant depression that have proven to be successful is constantly evolving. Combination treatment, including both medications and psychotherapy, Spravatoketamine infusions, and Transcranial Magnetic Stimulation (TMS) for treatment resistant depression may be viable options for you.

Treatment for Treatment Resistant Depression in Denver, Colorado

If you have not seen any positive results in your depression symptoms even after trying multiple antidepressant medications, you may have severe treatment-resistant depression. While this is a serious situation, the good news is that proper care and treatment can help manage depression for most people.

Axis Integrated Mental Health in Denver provides a full suite of integrated mental health treatments under one roof. For appointments, call us at (720) 400-7025 or fill out our contact us form today. 

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