Treatment-Resistant Depression - Dr. Samantha Torres, MD

TREATMENT GUIDE • OCTOBER 2003

Navigating Treatment-Resistant Depression:
Options and Hope

By Samantha Torres, M.D.
Board-Certified Neuropsychiatrist

>> What is Treatment-Resistant Depression?

Treatment-resistant depression (TRD) is generally defined as major depressive disorder that has not responded adequately to at least two different antidepressant medications, each given at an adequate dose for an adequate duration. If you've tried multiple medications without significant improvement, you're not alone—approximately 30% of people with depression experience some degree of treatment resistance.

It's important to understand: Treatment resistance doesn't mean your depression is untreatable. It means we need to look deeper, try different approaches, and often think beyond standard first-line treatments.

Before Assuming Treatment Resistance, Consider:
• Was the medication given at an adequate dose?
• Was it taken consistently for 6-8 weeks?
• Are there co-occurring conditions (anxiety, substance use, medical illness)?
• Is the diagnosis correct? (Bipolar depression requires different treatment)

>> Treatment Options Overview

When standard treatments haven't worked, there are still many paths forward:

Category	Options
Medication Strategies	Switching, combining, augmentation
Brain Stimulation	ECT, TMS, VNS
Psychotherapy	CBT, IPT, CBASP
Novel Approaches	Ketamine, research protocols

>> Medication Strategies

Switching Medications
If one class of antidepressant hasn't worked, switching to a different class may help. For example, moving from an SSRI to an SNRI, or trying a medication with a different mechanism entirely.

Combination Therapy
Using two antidepressants together that work through different mechanisms can sometimes produce better results than either alone.

Augmentation
Adding a second medication to enhance the effect of your antidepressant:

Lithium - One of the most studied augmentation strategies
Thyroid hormone (T3) - Can boost antidepressant response
Atypical antipsychotics - Several are FDA-approved for augmentation
Buspirone - Sometimes helpful when added to SSRIs

Genetic Testing
Pharmacogenomic testing can identify how your body metabolizes certain medications, potentially explaining why some haven't worked and guiding selection of alternatives.

>> Beyond Medications

Electroconvulsive Therapy (ECT)
Despite its portrayal in media, modern ECT is safe, effective, and often life-saving for severe depression. It remains the most effective treatment we have for treatment-resistant depression, with response rates of 50-70%.

Transcranial Magnetic Stimulation (TMS)
A newer, non-invasive option that uses magnetic pulses to stimulate specific brain regions. FDA-approved for treatment-resistant depression with a favorable side effect profile.

Vagus Nerve Stimulation (VNS)
An implanted device that provides regular stimulation to the vagus nerve. Reserved for severe, chronic cases.

Intensive Psychotherapy
For some patients, particularly those with trauma histories or chronic interpersonal difficulties, intensive psychotherapy may be the missing piece.

>> Reasons for Hope

If you're struggling with treatment-resistant depression, please know:

New treatments are being developed and approved regularly
What hasn't worked before doesn't predict what might work next
Many people eventually find effective treatment after multiple trials
Each failed treatment provides information that helps guide the next step
You deserve a physician who will keep searching with you

Specialized Care for Complex Depression

Dr. Torres has extensive experience with treatment-resistant mood disorders and can provide comprehensive evaluation and advanced treatment options.

--> Schedule a Consultation <--

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>> Contact Info

Phone:
(909) 390-0003

Email:
appointments@
drtorresmd.info

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