At Therapath we won't back down from treatment resistant depression and we don't want our patients to either. There are options.

The term treatment resistant depression (TRD) may seem daunting, but it doesn’t mean there’s no path forward. With the right combination of care and specialized providers, relief is achievable, and hope is very much alive.

However, TRD is not a one-size-fits-all diagnosis. Individual biochemistry, health history, and life circumstances vary, making it crucial for providers to tailor their approach.

Here are a few insights into treatment resistant depression and why Therapath Mental Health has team members who specialize in finding solutions for those whose struggle with depression that won't go away.

What is Treatment Resistant Depression?

Treatment resistant depression, TRD, is a term that patients and providers - almost by definition - struggle to pin down. This is for good reason: no two people experience major depression in the same way. TRD typically refers to cases where two or more medication trials from different drug classes fail to alleviate depression symptoms.

Dr. Arif Noorbaksh MD, Founder of Therapath Mental Health, and a psychiatrist who specializes in caring for people with TRD explains:

"There is a general consensus definition of Treatment Resistant Depression: two adequate trials of oral medications from two separate classes. That being said the term requires conversation, education, and a deep understanding of each patient’s unique history. It’s not just about medications—it’s about a comprehensive approach to care."

Clinicians who specialize in TRD evaluate responsiveness to psychotherapy, lifestyle interventions, medication tolerance, and timing between treatment trials to fully understand TRD’s impact on a patient.

How Common is TRD?

While many individuals find relief from their first prescribed antidepressant, studies show that subsequent trials are less effective, leaving an estimated 30% of patients with major depression needing advanced care plans. Despite these statistics, there are still many options, which is why the term treatment resistant must be understood as a diagnostic tool, not a final verdict.

But, if there are more options to pursue, why use the term at all?

Why Diagnosis Matters

"The concept of treatment resistance is important for two reasons. First, response to subsequent med trials will likely be negligible, and second this label is required to get patients to more efficacious treatment like Spravato and TMS," Dr. Noorbaksh explained.

Further oral medications, without a proper reevaluation of treatment planning is not likely to help a patient achieve remission. Proper diagnosis ensures patients gain access to the resources they need, often with the help of insurance. It also pushes providers to explore potential factors influencing treatment outcomes, such as underlying health conditions or environmental stressors.

"I personally haven’t had a patient have a problem with this label once explained, and many times it has helped me make the case for more comprehensive care like weekly or more psychotherapy. All the label means is that another oral medication alone is unlikely to get us to remission. We need to go further," explained Dr. Noorbaksh MD.

The Importance of Therapists and Psychiatrists Who Specialize in TRD

Dr. Noorbaksh suggests that the term itself is a call to action for providers. "[Treatment resistance] is not absolution; it’s a flag. We need to lean in and do all the things we know can be helpful - that aren’t a bunch more med trials."

Effective treatment for TRD requires a team of professionals committed to collaboration.

Taking a fresh look at patient's predisposition, current and past health and lifestyle factors, symptom history, medical comorbidities, history of or current substance use, and their experience taking previous prescriptions all play a role. At Therapath Mental Health, providers perform thorough 60-minute intakes, considering all aspects of a patient’s physical, emotional, and social health. Psychiatrists and therapists work together, consulting on cases weekly, and maintaining open communication with external providers to ensure seamless care. This can ensure nothing is missed, the diagnosis is appropriate, and the patient has time to connect and collaborate on their treatment plan. This integrated approach also ensures that patients feel supported and never left to navigate complex treatments alone.

Treatment Beyond Prescriptions

Treating TRD effectively often means moving beyond medication. Those dealing with major depression are more likely to feel better with a combination approach. Psychotherapy and pharmacotherapy tend to offer better results for those with major depression, than one treatment alone.

Interventional treatments like TMS, ECT, esketamine, or ketamine can also provide significant relief when used carefully and in conjunction with therapy. However, despite it's current popularity ketamine treatments should not be taken without caution. "Ketamine should be used with the same care as any other pharmaceutical. Without an integrated treatment plan, such as the addition of ketamine informed therapy and direct clinical monitoring, harm can happen," Dr. Noorbaksh warns.

Psychiatrists who specialize in working with patients who have treatment resistant depression may also look beyond pharmacology and psychotherapy to offer a holistic plan. There are many low-risk, adjunctive treatments that can be added to combination care to improve a patient's quality of life.

Supplementation, light therapy, and lifestyle changes such as exercise and nutrition help with symptom reduction and long-term better health. Remission that lasts requires monitoring symptoms, maintaining new lifestyle changes, and continuing to engage in psychotherapy to put coping skills and new behaviors into action.

Finding Hope in Comprehensive Care

For individuals struggling with TRD, the path to relief may feel long, but it’s not impossible. With specialized providers, thorough evaluations, and an integrative care plan, even the most persistent depression can be addressed. At Therapath Mental Health, the focus is on providing the expertise and support needed to uncover solutions and restore hope.