Depression itself is not a specific mental health issue in itself; instead, there are many different types of depression – each including different signs, symptoms, and general effects.
Because of this, it can be hard to determine what type of depression an individual has, as well as whether they are struggling with just one form or multiple forms of depression.
The Office for National Statistics (ONS) reported that around 1 in 6 adults experienced moderate to severe depressive symptoms in 2022 – an increase since the pandemic (COVID-19), and also heavily impacted by the cost of living crisis – but a vital statistic, nonetheless.
This shows how vital research is into depression in general, as well as more specific types and effects.
This blog, for example, will focus on Treatment-Resistant Depression (TRD).
This is a mental health condition where an individual’s depressive symptoms continue, despite focused treatment and treatment programmes.
This can be considered as a form of major depression i.e., one that is of high severity and consequence.
If it is discovered that an individual appears to be suffering from treatment-resistant depression (by showing common symptoms of depression), then they will usually be transferred to alternative treatment programmes – one of the most common of these programmes being a course of antidepressants. [2]
Medication is often one of the first treatment options offered to individuals with TRD and, although it is not always the most suitable, it may be beneficial when used in conjunction with additional treatment programmes such as therapy and counselling.
However, one American study found that individuals struggling with depression may be more likely to show signs of non-adherence (i.e., not taking their prescribed medication), [3] when compared to individuals on medication courses that do not struggle with depression.
This shows that although medication may be a good treatment in the relative long term, it is also risky when not correctly monitored, prescribed, and adhered to.
This should always be discussed with a medical professional, especially if an individual feels as though medication is the best next step for them.
As mentioned above, depression is often best treated when combined with additional treatment programmes such as therapy, holistic treatments and alternative treatments.
Therapy, including counselling, is one of the best ways to treat depression, as it is often considered and applied as a method to discover and treat the root causes of the individual’s symptoms of depression.
From this, an individual would be able to make meaningful changes to their thought patterns, lifestyle and other related factors that are found to be involved.
One of the most effective forms of treatment for depressive issues, as well as other mental health issues in general, is Cognitive Behavioural Therapy (CBT).
This is a form of therapy that involves identifying negative thought patterns and/or feelings about oneself and working on solutions and coping mechanisms to deal with these issues into the future and in the long term.
When an individual is first diagnosed with depression, it is unlikely that they will be immediately prescribed a long list of treatment programmes.
This is mainly because the true depth of an individual’s experiences and associated effects of depression may not be instantly clear.
Instead, it is likely that individuals will begin with a few forms of treatment, such as entering therapy or beginning to take a low dose of medication.
Once an individual’s situation is better understood, it is then far more likely that they will gain a greater understanding of what is beneficial for them, what will treat their specific symptoms, as well as the general treatments that will work best for them.
In some cases, individuals may begin specific forms of treatment and then realise later down their treatment programme progression that this form of treatment is not beneficial for them – though there may be elements that work for them, leading to a greater understanding in the future.
In all cases of diagnosing and treating depression and related mental health issues, it is important that the individual struggling with the disorder is honest, open, and communicative about the effects that they are experiencing.
Not only will this allow the individual to have a greater understanding of their own progression (when compared over long periods of time to the symptoms at the beginning of their treatment), but it will also allow those who are providing the treatment to give better suggestions, treatment options, and alternatives in the cases where a specific treatment programme may not be as effective as expected.
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Though the general symptoms of depression will vary from individual to individual, there are some key symptoms of depression and TRD that make it especially different and unique from other types of depression.
The key factor of this is that the depression presents itself in a ‘non-treatable’ way, meaning that the individual may feel as though any treatment programmes that they are taking part in are not being effective, even if they are committing fully to them, and are fully motivated.
However, it is important to note that these individuals may not actually be in the most suitable treatment programmes for their specific needs and requirements.
Therefore, even though these individuals are present and committed to their treatment programmes, they may not be seeing or feeling any progress.
This is, however, completely due to the forms of treatment that these individuals are committed to and may not actually be a reflection on the ‘treatability’ of their mental health issues and mental disorders at all.
Studies have cited that although there is a high risk to the economies and public services within areas of high TRD prevalence, [4] there may not be a specific age group or demographic that is more or less susceptible to this form of depression.
In general, it is often agreed that young adults and young individuals in general are more likely to experience depression as a population group, but this is not always the case.
It is generally thought that young adults, for example, are under additional pressure or face different struggles than other age groups, meaning that they are more likely to develop depression or depressive symptoms.
The following subheading outlines this in more detail.
Young adults, often considered to be from around their mid-20s to mid-30s, are a very unique age group, mainly due to the pressures and responsibilities that these generations face on a daily basis.
For example, individuals in these age groups are not often high in the ladder of progression within their careers (in general – not every case) and therefore may be more likely to be making a smaller salary than those that are higher in their careers – the older generation, for example.
This, when combined with the rising issues surrounding the cost of living, increasing bills, and mounting global issues, can have serious repercussions for mental health.
This may be a reason why individuals in this age group are therefore more likely to struggle with issues relating to depression [5] – including the development of TRD.
One of the key qualities of TRD, and what makes it ‘treatment resistant’, is that some forms of treatment may initially appear inconsequential, either in the short-term or in the long-term.
This means that individuals who are diagnosed with TRD may begin to experience some form of placebo effect.
For example, not many mental health professionals are likely to diagnose an individual with TRD as it has the implication that no form of treatment will improve the situation.
By telling someone that they cannot be treated, this may serve as a placebo, meaning that they will resist treatment purely because they have the preconception that it will not assist them.
Mental ‘blocks’ such as this can have serious implications for the effectiveness of different current medications and treatment options, leading to the belief that the individual will continue to struggle with depression, even after partaking in effective treatments such as a combination of antidepressant medications and other treatments.
The type of antidepressant [6] may also have a heavy impact on the suitability for depressed patients and those who struggle with depressive episodes.
For example, depressive episodes may occur, making individuals feel specific emotions – such as the feeling that their medical condition is unimproved by a course of antidepressants.
There is no defining research on the prevalence of TRD, [7] though this may be mainly down to the fact that most of these individuals find success and effectiveness from more suitable treatment programmes in the future.
Because of this, determining how common or uncommon this specific form of depression may be is incredibly difficult, and will require far more specific research in order to explore the symptoms and effects in more detail, as well as finding out how many individuals may be susceptible to the disorder based on pre-existing factors.
For those individuals who are diagnosed with TRD and have been living with it for long periods of time, there are many ongoing and further treatments and programmes that these individuals may take advantage of.
In most cases, these methods of further and ongoing treatment often involve the constant evolution of their treatment programmes, as well as a method of ensuring the individual’s ongoing comfort and relative well-being.
This may entail the inclusion of additional therapies, depending on the individual’s satisfaction in other areas of their life i.e., beginning marital therapy or commitment therapy should their TRD be related to their relationship, for example.
Marital and commitment therapy, however, are very specific forms of therapy and should only be considered if they are relevant.
The following subheadings outline some of these further treatment types, various other factors that affect TRD, as well as programmes that individuals struggling with TRD may be encouraged to join and/or partake in as a part of their long-term care.
In many cases, individuals struggling with addiction, also known as a substance use disorder, are often reported to have co-occurring disorders i.e., additional mental health issues that occur alongside the effects of their addiction, as well.
Depression is one of the most common co-occurring disorders, alongside other mental health issues such as anxiety, bipolar disorder and schizophrenia.
However, when an individual is struggling with both addiction and TRD, it can be difficult for them to overcome either.
This is due to the effects of both – they are both extremely taxing mental health issues, meaning that an individual’s mental health may be far more likely to suffer, making long-term progress slower and the journey to recovery seem impossible.
In some cases, individuals struggling with TRD may be referred to supported living, especially if it is something that they have been struggling with for a long period of time.
Ongoing depressive symptoms can often be extremely draining on an individual, leading to additional mental health struggles and mounting issues that can become ‘too much’ for an individual to deal with themselves on a daily basis.
In some cases, between treatment courses and programmes, it may be suggested that an individual enters some form of supported living i.e., where they live in their own space, but are provided with support whenever needed and are consistently monitored.
This is a common form of serious depression treatment.
This may lead to a higher likelihood of the individual’s positive well-being and health, in general – just by having a constant form of support and a strong social network within this arrangement.
In some cases, individuals may need to take their care to a more full-time level, meaning that they may need to consider options such as private inpatient treatment.
This is where an individual will move – full-time – into a designated establishment, specialising in the treatment of and care for individuals who are struggling with complex mental health issues.
TRD is a good example of a mental health issue in which an individual may need this form of care.
This is because the individual is living within one area and can be carefully monitored, both in terms of their health and well-being, but also in terms of the success of their treatment programmes, meaning that any changes or alterations to their care can be made in a far more timely manner – something that is vital with time-sensitive mental health struggles such as TRD and addiction.
To find a suitable treatment programme or treatment provider for yourself or for someone you know, it is important that the individual struggling with these issues is honest about their situation, and includes the following information when speaking with a medical professional about the best next steps for them and their specific experiences of TRD:
If an individual is open about their experiences and specific effects of their condition, then it is far more likely that they will enter a form of treatment or treatment programme that is specialised to them and their needs.
To find out more about TRD, addiction, or any other issues mentioned in this article, please do not hesitate to get in contact with Rehab 4 Addiction today.
We specialise in suggesting the best forms of care for individuals struggling with a variety of issues – primarily addiction, but also including many other mental health issues and associated conditions.
To speak with a member of our friendly, confidential, and professional team, call our addiction support hotline for free on 0800 140 4690
[3] https://pubmed.ncbi.nlm.nih.gov/21533823/
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503923/
Boris is our editor-in-chief at Rehab 4 Addiction. Boris is an addiction expert with more than 20 years in the field. His expertise covers a broad of topics relating to addiction, rehab and recovery. Boris is an addiction therapist and assists in the alcohol detox and rehab process. Boris has been featured on a variety of websites, including the BBC, Verywell Mind and Healthline. You can connect with Boris online at LinkedIn or X.com.
