We established in our article about depression treatment now that there are many different forms of depression and that there are many different ways to go about the treatment of depression. This brings us to a sticky situation for patients and clinicians alike: what if the treatments don’t work?
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brought to light the fact that the anti-depressant medications on the market are no more effective than placebo when unpublished studies are taken into account.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.
Technically, treatment resistant depression (TRD) did not used to be called “depressive personality disorder.” In terms of dysthymic disorder you may also be thinking about depressive neuroses. Depressive pd wasn’t eliminated in the last DSM it was added in it (DSM-IV not DSM-IV-TR). Depressive personality disorder was actually added to the DSM-IV appendix as a disorder for further consideration and may be considered for inclusion in DSM-V. It is one of many reasons why depression may be resistant to treatment; TRD isn’t necessarily a single disorder, it can be caused by a number of different factors. The blog here offers some good recommendations, when it comes to treatment resistance you need to keep trying, and don’t be afraid to ask professionals about their treatment plan and the empirical support for it. Thanks for talking about this,
Todd
Thanks for offering this clarification, Todd. It sounds like we are in agreement on the basic idea that “depression” as we use the word encompasses such a broad range of psychological phenomena that it is diagnostically problematic. All the best, Marcus.