Unfortunately,situations come about when depression does not respond to conventional treatments available. This can be frustrating and certainly contributes to the morbidity of depression.If you have been with the same clinician,sometimes it can be helpful to obtain a consultation by another clinician who will examine the treatment history and perhaps make some other suggestions.
Sometimes lack of response to treatment is due to inadequate dosing or duration of medication trials or due to a missed diagnosis.Co-morbid conditions can make a depressive illness more refractory to treatment.Conditions that may co-occur with depression include anxiety disorders (panic disorder,generalized anxiety disorder,obsessive–compulsive disorder, social anxiety disorder),posttraumatic stress disorder (also an anxiety condition),attention deficit disorder, and substance abuse disorders.Further evaluation and treatment of other conditions may be necessary.Substance abuse treatment,for example,may need to be obtained in order for the depression to be adequately treated.
Sometimes a refractory depression is a missed bipolar depression,which may require the use of additional medications.Psychiatrists use guidelines in the treatment of refractory depression.Oftentimes,older antidepressants such as TCAs or MAOIs have yet to be tried,and also ECT may need consideration. Although all psychiatrists are trained in psychopharmacologic treatments,some individuals have a specific expertise in the field of psychopharmacology for depression.These individuals are typically associated with an academic institution.In addition,research protocols are usually being conducted in association with academic institutions investigating newer medications.Participation in a research protocol usually involves a comprehensive evaluation during which other diagnostic possibilities are investigated as well.
