Beyond Blue

Beyond Blue

Dr. Duckworth on Treatment-Resistant Depression

Here are some excerpts from Dr. Duckworth’s article, “Ask the Doctor: Treatment-Resistant Depression,” that I found on NAMI’s website. It provides an excellent overview of some steps that Beyond Blue readers can take if you are among those who haven’t responded to treaments in the past. You can read the entire article by clicking here.

It is frustrating for all involved when someone does not respond to treatments for depression that work for most other people. But we can’t accurately predict who will respond to a particular intervention, and some will be in the group called the “non-responders.” Calling them “non-responders” almost sounds like we are blaming them for not getting better, doesn’t it? Let’s not blame these people, but rather review some strategies to address treatment-resistant depression and discuss a novel treatment that has come down the pike.
With clinical (or major) depression, about 20 percent to 30 percent of people do not respond to treatment. We don’t know why; this is just the state of the field right now. The first thing I encourage people to do when they have not responded to treatment is to review the basics of their care, aside from medications. The foundations of self-care—aerobic exercise, eliminating toxic stressors, building supportive relationships, getting enough rest, and a healthy diet—are essential. If your thoughts are persistently negative, give cognitive behavioral therapy (CBT) a good trial in addition to your medicines. If there is not a CBT practitioner in your area, “Feeling Good: The New Mood Therapy,” by David Burns, M.D., is a classic guide with easy-to-read descriptions of CBT.


Most studies show that combining talk therapy like CBT together with medications produces a better result than either treatment alone. If your depression persists, think about other possible causes—could you have a medical problem like hypothyroidism that could explain it? This condition can be detected with a simple blood test. Could other medications you take be contributing to your depression? This is a common problem with beta blockers for high blood pressure, and also with some treatments for Parkinson’s disease. Alcohol can also complicate a depression picture, so attention to sobriety can be crucial.
There are also many subtypes of depression. For example, people with bipolar depression often have atypical symptoms—such as sleeping more and eating more—and this is a challenge to treat. Seasonal depression in winter can add to the picture, and light therapy can be helpful for that. Depression with psychotic features typically responds very well to electroconvulsive therapy, or ECT, also known as shock therapy.

  • Larry Parker

    The “novel treatment” to which Dr. Duckworth alludes is vagus nerve stimulation (VNS) — the implantation of a device in the neck to stimulate one of the key nerves between the brain and the rest of the body.
    I’ve personally worked with the New Jersey researchers studying VNS at the University of Medicine and Dentistry of New Jersey, and they seem convinced of its efficacy — although they also acknowledge there have been some quality control problems with the device manufacturer.
    Sometimes, we can’t win for losing :-(

  • BellaTerra

    Sorry to post in the wrong place, but how do we vote on the dolls in the video? :-) Thanks. BTW, I don’t like any of them. But then I kinda get everything I want anyway. :-) BUT if I have to vote for one, I vote from the first one — Barbies just don’t do it for me. :-O

  • snooky325

    A major factor involved in mental health is the persons awareness of the spiritual neccessities inherant in ALL humanity. specifically the need to follow an esteemed example. Without such focus the individual will only have themselves as reference. And this is the problem, they not being equipped with personal authority to incorporate themselves in to life because they have no life in themselves. They know this, but not consciously, it is the essence of personality which has developed without a life seeking imperative. All of us are challenged to acquire a source of reference greater than ourselves, an some of us choose wisely some do not. For them who choose themselves as the litmus of authority and example of esteem the expression of self-love runs the gambit of expression from Meglomania to suicide and everything in between with no real fulfillment in the efforts because of the ambition to want. This comes from the need to create and spontaneous creation is reserved for diety, this then causes envy in the person and again responses are comoprehensive as an expression of self-love.
    The answer is to give the sufferer a sense of worth thru esteem toward a good and gracious example. With limited choices we must then understand the character traits of the exeample proposed to emulate. If such diety of individual choice is recieved then ambition for the patient will have a positive focus of expression. Encouragement for them and everybody is essential to good mental health. As hope is more to be expressed in love so we choose to express love rather than correction for the ailing soul.

  • Larry Parker

    (with credit to Liz Spikol of Philadelphia for highlighting the article in her blog …),tucker,77846,2.html/1
    An absolutely harrowing tale of treatment-resistant depression and ECT, VNS, and the other methods used when — as the protagonist hauntingly put it, depression becomes like an amped up (pardon the pun) version of anorexia. Instead of purging seeming, temptingly, like the only solution, 24-7, suicide seems like that solution 24-7 instead.
    The article, sadly, makes VNS sound like Topamax (which I was on for a couple of years) — a so-called miracle treatment with minimal side effects which instead has not-inconsiderable side effects for the price of being almost completely ineffective. (Sigh.)

  • Larry Parker

    I missed a sentence to close the third paragraph of my previous post (i.e., after “suicide seems like that solution”):
    “So to clinicians — and perhaps not wrongly, from their perspective — keeping someone alive becomes not just the highest priority but the ONLY priority. Never mind side effects; never mind memory loss; indeed, never mind giving someone the very ability to ‘live’ as opposed to merely ‘existing.'”

  • Lori

    I know that only I am responsible for my well being, all and all. STill sometimes I get angry (which is new to me, amongst most feelings)when I realize I am somewhat treatment resistant, only because it always returns, and it is so easy to return to feeling hopeless, or finding comfort in that. This has gone on for 8 years, before that the word depression, held little meaning.
    It is a down time, and it is so easy to want out. I need to have the desire (which is the tough part) to tell myself that I dont really want to leave the earth, I just want something different then what is, in this present moment. And no matter what I do with the momnent, it is better then checking out. Even if I quit my job, and hibernated in a mountain cabin and wrote songs and recorded for the next six months (that is what I really want to do) (If I had the guts)
    doing that and pissing off my spouse, due to bills, would be better then suicide, just because I am unhappy with my lifestyle.
    anyway, I didnt eat the baneberries yet today, they are just hanging out in my purse.
    I wonder if the professionals realize how dangerous it is for us folks, who fall through the cracks, just hanging on some days, in the midst of scary thoughts, hoping that hitching a ride on someones prayers is enough strength.
    thanks for listening

  • Larry Parker

    One of the things I’ve learned this year with help from my DBSA support group, from BB, and from the Bnet discussion groups on depression (which is probably not going to be very comforting) is that anger doesn’t necessarily mean your depression is treatment resistant.
    Rather, increased feelings of anger are almost inevitably a part of depression/bipolar, even if you have a good regimen of medication for your illness. The disease makes our emotions more volatile, even if it is fairly well treated. Nothing we can do, at least directly.
    But that’s one of the big reasons (besides the anxiety we all experience, of course) why we’re so encouraged to use relaxation techniques — meditation, exercise, “count to 3 (or 10),” and the like.
    Believe me, I’ve not only been there, I’M THERE. I am constantly thinking, “I never used to be this angry.” And I wasn’t — until my diagnosis a decade ago :-(
    Hang in there!

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