Why is therapy not working against depression? 

There are several reasons for therapy to not be helping your depression. Reasons may range from not having a good therapist, using the wrong approach, or even the fact that you may have Treatment resistant depression (TRD). 

In this brief blog we will discuss what treatment resistant depression is, reasons for it to occur, different ways of reaching remission and different approaches to help against treatment resistant depression. 

Why is therapy not working against depression? 

Even though you may be seeing a therapist, taking your medications and following your doctor’s advice, you might feel like it’s taking forever for them to help.

Psychotherapy — or “talk therapy” — is an effective treatment for clinical depression. On its own, it may not be enough to treat severe depression. But it can play an important role when used with other treatments, including medications.

Unfortunately, depression treatments don’t always work. As many as two-thirds of people with depression aren’t helped by the first antidepressant they try. Up to a third don’t respond to several attempts at treatment. 

In major depressive disorder, complete remission of symptoms is the optimal therapeutic goal. Remission occurs when the patient fully recovers psychosocial functioning with a minimal burden of residual effects. 

However, despite the rapid evolution of pharmacological therapies over the past 50 years, research shows that only 60% to 70% of patients who respond to first-line monotherapy. 

Treatment-resistant depression (TRD) can leave you feeling hopeless and discouraged. Months or even years can go by without any relief. And after the effort it took to get help, it can be demoralizing when you’re just not getting better.

Reasons for Treatment-resistant depression (TRD)

  • Your age, gender and health status may increase your risk for treatment-resistant depression.

Researchers have observed that certain groups of people may be more susceptible to depression and are at risk for becoming treatment-resistant. For example, this is particularly true of women and senior citizens. 

Particularly vulnerable are those who experience depression frequently and severely (not necessarily the same things). Also at high risk are those who’ve experienced previous bouts of severe depression. 

Patients with depression who have some medical illnesses—such as thyroid disease and chronic pain—are at greater risk for TRD. Other diseases linked to TRD include drug misuse, food and sleeping issues, all of which have the potential to make you more resistant to antidepressant medication.

  • Depression might have unknown origins, which could explain why standard treatments don’t work for everyone.

While the biology of depression is still largely a mystery, the most popular theory is that it’s caused by low brain levels of such neurotransmitters as serotonin and norepinephrine, which are associated with feelings of happiness and well-being.

But recent research suggests that although neurotransmitters may be a large part of the reason why people experience depression, they aren’t necessarily the only factor. For example, a person’s outlook on life plays a big role in their chances of becoming depressed as well—so more and more evidence is beginning to suggest that medication alone might not be the most effective treatment for everyone who suffers from depression.

  • Treatment-resistant depression can be managed using proven techniques.

Obtaining treatment solutions can seem challenging, but there are a number of tools and resources that exist to help people go through the process effectively.

A 2012 study published in the journal Patient Preference and Adherence identified five main treatment strategies—optimization, switching, combination, augmentation and somatic therapies—that psychiatrists can use to create a personalized plan for patients.

There are other somatic (non-drug) treatments, such as transcranial magnetic stimulation (TMS), which targets nerve cells in the brain’s mood regulation and depression area, and electroconvulsive therapy (ECT), which causes changes in brain chemistry to help reverse TRD symptoms.

Let’s continue to look at ways that can help facilitate remission. 

Your therapist should be the first person you contact if therapy isn’t working. She may decide to adjust her therapy method, give you extra “homework” options, or recommend you to another therapist. Make certain you inquire about the following:

  • What treatment method are we using, and is it too early to try a different approach?
  • Could medication help? What about lifestyle changes?
  • Is there anything I can do to improve the treatment’s efficacy?
  • Psychological Counseling

As we all know, different people respond differently to specific treatments. But there’s a chance that you’ll find the answer you’ve been looking for. 

Psychotherapy is often seen as the gold standard treatment due to its success rate both in conjunction with medication when necessary and alone in cases where medication has not worked out for patients well. 

It can help identify underlying concerns that may be adding to your symptoms of mild depression because at the heart of this form of therapy is continued communication between practitioner and patient.

As a therapist will work closely with you, it’s your responsibility as a client to listen and share any concerns that are important or come to mind whatsoever during the process so as not to let symptoms worsen like those of social impairments or other chronic physical conditions like arthritis which could potentially affect our quality of life.

If counseling doesn’t seem helpful, talk to your psychotherapist about trying a different approach. Or consider seeing someone else.

Side Note: I have tried and tested various products and services to help with my anxiety and depression. See my top recommendations here, as well as a full list of all products and services our team has tested for various mental health conditions and general wellness.

Different approaches to treating depression:

Cognitive behavioral therapy 

One therapy approach deals with how you think; how you feel and how you act. Some common thoughts that could be causing you stress or contributing to your depression are negative thoughts about yourself, others or the world. 

The goal of this type of counseling is to help you identify patterns in your thinking, feelings and behaviors that affect your mood so that you can manage your symptoms more effectively.

Interpersonal psychotherapy. 

Interpersonal psychotherapy focuses on resolving relationship issues that may contribute to your depression.

Dialectical Behavioral therapy 

Dialectical Behavioral Therapy (DBT) is one form of psychotherapy that helps patients learn to accept their emotions without letting them overwhelm them and without resorting to self-injury. It also teaches patients how to find alternative ways of handling things when they feel suicidal or depressed, which are usually more constructive than harming yourself.

Acceptance and commitment therapy

Acceptance and Commitment therapy is a form of cognitive behavioral therapy that teaches you to live a more positive lifestyle despite the difficult thoughts and emotions that might be brought on by your condition. It’s designed for treatment-resistant conditions, even though it can work with some forms of treatment.

Acceptance and commitment therapy helps you to engage in positive behaviors, even when you have negative thoughts and emotions. 

The bottom line with ACT is that despite whatever hurdles may get in your way, the real work lies in how you respond to these setbacks. It’s important to remain strong within yourself, no matter what circumstances are presented before us because nothing will ever change until we stop resisting (and just accept) our suspicions that we’ll never be able to navigate life without experiencing some hiccups along the way!

Family or marital therapy

This type of therapy involves family members or your spouse or partner in counseling. Working out stress in your relationships can help with depression.

Group psychotherapy 

This type of counseling involves a group of people who struggle with depression working together with a psychotherapist.

Behavioral activation 

Many sufferers of depression are usually withdrawn and isolated, which makes it difficult for them to reintegrate into society. As such, Behavioral activation treatment often focuses on gradually increasing social activities or engaging in activities that the person has previously enjoyed in an attempt to reintroduce them back into society.

We understand how difficult it may be to start or restart therapy. It’s very normal to have moments when you ponder quitting up. Allow yourself to take a breath and a pause in certain situations. When you’re ready, you may begin again. 

Remember: finding a solid fit between you and a mental health professional, the right approach and the perfect medication, may lead to significant change, and we’re here to support you along the way.

What we recommend for Counselling

Professional counselling

If you are suffering from depression or any other mental disorders then ongoing professional counselling could be your ideal first point of call. Counselling will utilize theories such as Cognitive behavioural therapy which will help you live a more fulfilling life.