Treating Medication-Resistant Depression

As it turns out, I don’t respond to psychiatric medication.

I’ve tried dozens of mood-lifting pills in the past decade, and none of them has consistently worked. Those that do create any beneficial effect usually only do so mildly, and they wear off in a matter of weeks, leaving me just as despondent as I was before.

I have a biological resistance to meds. I know that because a) I’ve been trying them for ten years, which is long enough to know that they don’t work, b) I’ve tried many different types of meds, c) I’ve been on therapeutic doses of all of those meds, and d) I was given prescriptions for them from certified psychiatrists who expected to see them work more effectively than they did.

Had any of those criteria not been met, I wouldn’t claim to be medication-resistant, because there would be a chance that I didn’t try every possible opportunity to respond well to medication. As it is, however, I’ve exhausted every option and tried every avenue of finding meds that work on my depression, and I’ve still come up with nothing.

If you find yourself relating to my story of taking therapeutic doses of many different prescription pills for several years and still seeing next to no improvement, you may have an uncontrollable, biological resistance to psychiatric medication.

And, while that sounds scary, it’s okay.

You’re not out of options just because Paxil doesn’t lift your mood. While inconvenient, there are work-arounds to psychiatric medication resistance. One for which I can personally vouch is electroconvulsive therapy (ECT), which is an extremely effective antidepressant treatment that I have been receiving for the past several months, and which I explain in more detail here. Essentially, during ECT, the depressed patient is anesthetized and an electric current is non-invasively sent through their head, causing a short, controlled seizure. The body’s response to the seizure causes a biological lift in mood. This procedure is repeated periodically over the course of several months.

The problem with ECT, however, is that its side effects force patients to give up things they can’t always afford to lose, like the ability to drive, navigate, or retain certain memories while the procedures continue. And while it’s an outpatient process, it does take several hours to recover from general anesthetic, which means sacrificing one or more whole days a week for several months. While I’ll firmly argue that it’s worth not being able to drive for a few months in order to become mentally healthy, I understand that some people need to drive for job- and career-related reasons that they can’t always easily forfeit.

There are options besides ECT, however, which don’t involve as much anesthesia. Repeated transcranial magnetic stimulation (rTMS) is an increasingly popular treatment for unipolar (as opposed to bipolar) depression. During rTMS, a magnetic coil is pointed at the patient’s head at a particular angle. The current it generates interacts with the patient’s brain in such a way that depressive symptoms clear up. While the procedure does have to be performed repeatedly and can cause side effects like headaches, it’s a relatively simple treatment, especially given the wonderful effect it can have on a person’s mood.

Not every mood treatment is noninvasive, however. In more severe cases, vagus nerve stimulation (VNS) is an option for lifting depression. In VNS, a device called a pulse generator is implanted in the patient’s chest, where it’s used to stimulate the left vagus nerve. The vagus nerve painlessly communicates signals from the pulse generator to the brain for ten years, at which time the generator’s battery is replaced and it operates for another decade.

VNS is a surgical process, but on the upside, it operates automatically for years at a time, and the implantation process doesn’t need to be repeated as often as ECT and rTMS do. And the signal transmission process that takes place between the pulse generator and the vagal nerve is painless, which is another benefit of VNS.

I am, fortunately, a statistically unusual case when it comes to psychotropic medication resistance. I say that’s fortunate because it means that psych meds work on most people who need them. The average person with a psychiatric disorder – let’s use depression as an example, since it’s so ubiquitous – finds themselves feeling better after just a few weeks of taking an antidepressant or two. Maybe they don’t feel perfectly back to normal because of one pill, but at the very least, they’re likely to feel better. For the sake of improving the lives of most mentally ill people, I am a firm believer in psych meds – just not in my case.


14 thoughts on “Treating Medication-Resistant Depression

  1. We are currently doing low dose ketamine (.5mg/kg) infusion at the hospital I work at for those that do not respond to antidepressants or ECTs. The infusions are over 45 minutes twice a week for 3 weeks. They show immediate results on two depression scales. Some come back for maintenance, but it really seems to help!


  2. Thank you for sharing this; it’s always good to learn new information and to have to share should someone come to mind that this would be the perfect fit for! All the best to you and looking forward to future blogs.


  3. I work with teens with mental illness. One of the tools I’ve seen used more frequently over the last few years is DNA testing. You can actually tell if someone is say, resistant to zoloft and all meds in zolofts class, through testing their DNA rather than by making them take zoloft at an ever increasing dose for a few months until you max out, decide it has no effect, titrate down again, and repeat the process with something different. Are you guaranteed to find an effective medication? No. But you’re also not going to waste months of your life popping pills and enduring the side effects of medications that are not helping your depressive symptoms.


  4. Thank you for sharing your story. I have been on anti-depressants for over 30 years and now have found myself only responding for short periods of time (3-6 months). It does frighten me…when I was a young nurse, I participated in assisting with ECT (in 1970’s). I am sure that the method has changed but, having seen it before, frightens me beyond words. Again, I realize that was almost 50 years ago but I am glad that other treatment options are becoming available. It is a horrible disorder that, to this day, so many people do not understand. I, too, am looking forward to reading your blogs.


    1. Hi Ginger. I don’t know what ECT was like in the 70s, but if it was scary then, I can guarantee that it’s been improved drastically. There’s nothing frightening about it now. I can highly recommend the process should all else fail. Thank you for reading.


  5. I also have borderline, bipolar too, and I am also medication resistant. My depressive modes are hard to treat and we are having some luck with Latuda. It won’t last, that I know. In the meantime, it is DBT as much as I can to help prevent the worst of the depressive episodes and to fight through SI. Sadly, borderline can’t be treated by meds, and though I am fifty, it is as intense as ever. I just often wish there was a quick fix. I know, however, that I have years of hard work ahead of me.


    1. One thing I’ve found helpful is knowing that my treatable symptoms tend to make my untreatable symptoms worse. For example, more depression means more difficulty socializing. When I treat one condition – like I treated depression with ECT – the other becomes much more manageable.


  6. I also am not responding to meds any longer. I’ve tried them all over the last 40 years. I paid 10k out of pocket for TMS. It didn’t help.
    I’m interested in ketamine.
    Can’t risk side effects of ECT. I’m still working.


  7. I too have borderline and had severe crushing depression and anxiety from it (and my shitty childhood) for twenty years with intolerable side effects from every single med I tried. However, my husband’s doc pointed me to DBT and after a year I was cured of both the depression and anxiety, which is seriously something I never thought would happen. I’m still borderline and it’s still work to live normally, but DBT genuinely saved my life. I highly recommend it, although it is hard to find a good psychiatrist who does straight up DBT.

    As for ECT, I have a friend who tried to kill herself and got several courses of ECT in the mental ward… She now has serious problems with long term memory and doesn’t remember anything from that year… Between the memory issues and the anxiety I’m not sure she’ll ever work again…


    1. Wow, I’m seriously impressed and cheered up by your story of doing DBT and recovering. Sincerely, that’s amazing.

      I’m sorry your friend is still having effects from ECT. The memory stuff is really annoying – I can testify to that for sure. However, it’s better than depression. I hope she’s able to work again, but if she isn’t, I hope ECT helped her recover enough that it was worth it.


  8. Thank you for writing about this. I’ve been told not only do I have treatment resistant depression but I also have double depression. Have you heard of that? Chronic low grade depression with bouts of major depression thrown in for fun. I, too, tried dTMS to the tune of many thousands of dollars. It doesn’t last. It does work, but it doesn’t last. The last thing we tried has been adding Topamax. For awhile there my SI actually went away. It’s back now.
    What have you heard about taking psilocybin in a controlled setting, assisted by a therapist? Has it been approved by the FDA yet for use in extreme cases?


    1. Hi Beth. I haven’t heard of double depression; if it’s in the DSM, I haven’t seen it. My doctors have never mentioned it as far as I’m aware, although it sounds like it might describe me, too. I haven’t heard of psilocybin as an antidepressant, either. That’s a great question for your psychiatrist. Therapists aren’t medical doctors and can’t prescribe substances. Only a psychiatrist can do that. Sorry I can’t be of more help! -Z


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