Treatment-resistant depression sometimes begins early on in life and continues from there. This used to be called depressive personality disorder, but this diagnosis was eliminated in the last update to the Diagnostic and Statistical Manual. Now there is dysthymia, which is long-term, low-grade depression, and major depressive disorder, chronic.

In reality, all of these diagnoses don't matter. What matters is the experience of the person going through these problems and what can be done to make things better for them. Often what is called "treatment-resistant depression" is simply not improving because the wrong treatments are being tried. I believe that everyone can get better, but that people are very complex organisms which need to be delicately examined and carefully understood in order to find the source of problems and their cures.

Medication is not the answer. Sometimes it can be helpful, for some patients, and for a certain period of time. But so can a sugar pill. Recent exposes have brought to light the fact that the anti-depressant medications on the market are no more effective than placebo when unpublished studies are taken into account. Since they have substantial side effects, their widespread use in psychiatry is highly questionable. Psychotherapy has a better potential for long-term success. If medications are being used, psychotherapy should at least be used as an adjunct.

And for patients whose symptoms do not respond to psychotherapy after a reasonable period of time, another psychotherapist should be consulted and/or another method of treatment should be used. There are those who will argue that a patient should stay the course with their therapist no matter what because the relationship between therapist and client is the most important thing. I strongly disagree. Results are everything. You shouldn't go to therapy to have a friend, you should go to therapy to solve your problems and make your life better. That's not to say that the treatment will always be pleasant; often it will feel terrible. So does chemotherapy. The results are everything.

This may be because "depression" is such a nebulous term. Like every psychological disorder, there are specific diagnostic criteria for depression. However, there has been some debate about the validity of these criteria, simply because th symptoms are so common, cover such a wide area, and are subsumed by so many other psychiatric conditions. So you could say that there are as many treatments for depression as there are types of depression.

Is this debate useful to the individual who is suffering from poor mood, troubled sleep, disturbed appetite and sexual functioning, low energy, decreased motivation, suicidal thoughts, etc? I would say that it is. I think that there is a basic trouble in the modern art of psychological diagnosis. Psychologists and psychiatrists have tried so hard to quantify and categorize mental illness, and mental illness has meanwhile stubbornly refused to fit into our categories.

At the time of this writing, the American Psychiatric Association is in the process of developing a new version of their Diagnostic And Statistical Manual of psycihatric disorders, which is used for clinical diagnosis and insurance reimbursement. This process has sparked fierce debate from all sides, because it is difficult to agree on what the functioning purpose of the diagnoses should be. Should it be to allow individual diagnoses to reflect the experience of the individual patient as accurately as possible? To enable treatment planning? To minimize hassle from managed care? There are many groups who would like their interests to be represented by the formulation of psychological diagnosis.

This is a long way of letting you know that treatment for depression can involve pretty much any psychological treatment modality, because when we say you "have depression" it doesn't really mean very much. It is not the same thing as when you go to a physician for a throat culture and they can tell you definitvely that you have been infected by a specific type of bacteria. There is no blood test for depression, no specific set of physiological correlates. In fact, if we look at what is happening in the body there could be said to be a number of different types of depression that have so far been inadequately distinguished from each other.

This is not to say that depression treatments don't work--they do. They simply need to be formulated based on your individual experience as someone who is suffering something we are tenatively calling depression. In other words, we know many effective ways to treat these problem, we just haven't figured out the most effective way to catalog them yet. And as we get that figured out, we will probably develop even more effective treatments.

Depression Treatment Centers

All of this sounds like it could bode well for the idea of a specialty depression treatment center. Some type of clinic that would have advanced knowledge of the types of depression, the way they present themselves clinically, and what can be done about them. I am not aware that this type of facility does or even could exist. Depression symptoms overlap with so many other psychological maladies that you could just as well say "feeling bad" as "depressed."

Depression, along with anxiety, represents probably the most common and indistinct set of psychological symptoms. People experience depression symptoms during grief (although you should not receive a diagnosis of depression during the 'normal' grieving period, which has arbitraily been set at six months.) People experience depression symptoms during drug detox, or when suffering from insomnia, or when feeling lonely. You can get depressed because of another mental health problem, or depression can bring about other problems. You can get depressed because of the troubles in your life, or you can create trouble in your life on account of being depressed. You see the diffficulty that comes along with a diagnosis of 'depression?' It represents so many basic human experiences.