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Drug-resistant depression is a form of depressive disorder in which the use of two or more antidepressant treatments does not allow for satisfactory treatment results. The exact causes of drug-resistant depression are unknown, but it has already been noticed what factors increase the risk of this form of depression in patients.

What is drug-resistant depression?

Drug-resistant depressionhas at least a few definitions in the literature. Most often, however, this condition is diagnosed when a patient treated for depressive disorders with two or more antidepressant treatments fails to improve. It should be emphasized here that treatment-resistant depression can be diagnosed in a situation where the patient has been administered antidepressants belonging to various drug groups, and in addition, the therapeutic courses lasted for a sufficiently long time. When diagnosing drug-resistant depression, it is also taken into account whether the drugs used by the patient were selected in the appropriate doses and were taken according to the recommendations.

Depression is probably the most common psychiatric problem in society. Basically, this situation is not surprising - just look at the statistics on the incidence of depression in the human population. Currently, it turns out that every year depressive disorders occur in up to 15% of the entire population[1] .

Depression can definitely be treated as a serious he alth problem. After all, this unit influences the functioning of the patient himself, but typically it also influences his entire environment, including, first of all, the patient's family. There is no doubt that depressive disorders should be treated. However, the therapy does not always bring satisfactory results - some patients, unfortunately, suffer from drug-resistant depression.

Drug-resistant depression is seen more often than you might imagine. The statistics available on this subject may seem even disturbing: in even 2/3 of people suffering from depression, the use of the first drug does not lead to an improvement in their condition, and what is even worse - even over 30% of all patients do not improve despiteuse of various treatment options for depression[2] .

Looking at the numbers above, you can clearly see that the situation is far from perfect. But what is responsible for this state of affairs? At the moment, the causes of drug-resistant depression are not clear enough, but at least a few different factors have already been identified that may significantly contribute to the lack of success in treating depression.

Symptoms of drug-resistant depression

In general, symptoms of drug-resistant depression do not differ from those experienced by patients with other forms of depressive disorders. In the course of depressive states that do not respond to treatment, patients simply take the medications prescribed for them in accordance with the instructions, and yet their condition does not improve and their discomforts - e.g. a drastic depression, suicidal thoughts or anhedonia and sleep disorders and eating disorders - they are constantly present.

Factors increasing the risk of drug-resistant depression

In a situation where a patient treated for depressive states does not achieve a satisfactory improvement, first of all, it is necessary to exclude the aspects that are the causes of the "alleged" drug resistance of depression. We are talking here primarily about the improper course of treatment with antidepressants. It may turn out that the failure to achieve therapeutic success is related to the following:

  • the patient was advised to take too little antidepressant
  • the sick person (for various reasons) does not take medication as recommended
  • the side effects of the antidepressant are definitely unacceptable to the patient,
  • the patient actually suffers from a problem other than depression (e.g. thyroid dysfunction)

If the above-mentioned problems are ruled out, and in addition, the previously described criteria are met, then we can really talk about the existence of drug-resistant depression in the patient. Contribute to the fact that the patient may be struggling with this form of depressive disorder can, in fact, many phenomena. Among them, the following are primarily mentioned:

  • age (elderly patients have an increased risk that their depression will be drug resistant),
  • the existence of other diseases in the patient, apart from depression (this applies to both other mental disorders, e.g. anxiety disorders and somatic diseases, e.g. heart failure or diabetes).

Sometimes the underlying cause of drug resistance in depression may also be the fact that the patient's depressed mood is not due to the fact that he or she suffers fromdepressive disorder, and in fact it is burdened with a different type of affective disorder. We are talking about bipolar disorder (BD), i.e. a unit where depressive states are intertwined with manic states. Treatment of bipolar disorder is different from treatment of depressive disorders, which is why a patient with bipolar disorder who receives treatment typical for depression may not achieve therapeutic success at all.

Treatment of drug-resistant depression

It should come as no surprise that finding a drug-resistant form of depressive disorders in a patient requires intensified therapy. The basis in this case is usually a modification of the pharmacological treatment. The patient may be offered, for example, to change the antidepressant drug to some agent which operates in a different mechanism than the drug that has been used by him so far. The problem in this case is that first it is necessary to gradually discontinue the first drug, and then slowly implement the treatment with the new drug - in both situations, patients may encounter unpleasant ailments during these periods.

Due to the above-mentioned problem, sometimes instead of changing the patient's antidepressant drug, it turns out to be more beneficial to augment the treatment, i.e. adding another preparation to the drug already taken. Potentialisation of therapy in drug-resistant depression may involve prescribing an additional antidepressant to the patient, but agents from other drug groups, such as lithium carbonate, thyroid hormones or atypical antipsychotics, may also be added to the antidepressant.

The role of psychotherapy for the condition of patients with depression should not be forgotten either. After all, not only pharmacotherapy is important in the treatment of depressive disorders, but also psychotherapeutic effects and psychoeducation. The combination of properly selected pharmacological treatment together with work with a therapist can definitely increase the patient's chances of achieving therapeutic success.

Atypical depression can also be an indication for the use of one of the surgical methods of treating depressive disorders. In the case of such treatment options, electroconvulsive therapy (considered by many to be quite controversial) is most often still performed. In addition to electroconvulsive therapy, methods such as deep brain stimulation, transcranial magnetic stimulation or stimulation of the vagus nerve are increasingly being talked about in the treatment of drug-resistant depression.

About the authorBow. Tomasz NęckiA graduate of medicine at the Medical University of Poznań. An admirer of the Polish sea(most willingly strolling along its shore with headphones in their ears), cats and books. In working with patients, he focuses on always listening to them and spending as much time as they need.

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Psychiatry