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What Is Treatment Resistant Depression?

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Depression is considered the leading cause of disability worldwide, according to the World Health Organization. Approximately 264 million people globally suffer from depression, with an estimated 17.3 million adults in the U.S. reporting at least one major depressive episode in the span of a year.

Thankfully, treatment for depression has come a long way. With options such as therapy and medication(s), it is possible to manage depression and the accompanying symptoms. However, treatment may not always be as effective as we’d like it to be. When the symptoms of depression persist despite treatment, you may have treatment-resistant depression (TRD). Learn more about the warning signs of TRD, and what treatment options might help you manage your symptoms.

What Is Depression?

Depression is a mood disorder that negatively affects the way you feel, making it difficult to function throughout the day. There are many disorders that fall under the depression umbrella, such as bipolar disorder, postpartum depression, and seasonal affective disorder. The symptoms of depression, however, are similar across these different types. Symptoms last persistently and can include:

  • Feeling down or blue
  • Changes in your appetite
  • Lost feelings of joy from things that made you happy
  • Overwhelming fatigue
  • Difficulty getting out of bed
  • Thoughts of suicide or hurting yourself

Treating Depression

To appropriately treat your depression, you’ll likely start with an initial visit to your healthcare provider who may run several standard tests and blood work to rule out any other conditions. They will likely also review your family history for certain conditions like bipolar disorder, since bipolar can be genetic. You might also be referred to a psychiatrist or psychologist. You can speak to both your primary care provider (PCP) and psychiatrist about medication options. Additionally, a psychiatrist or psychologist can provide counseling sessions.

Along with other treatment options, your PCP may prescribe an antidepressant. An example of some commonly used antidepressants include sertraline (Zoloft) or escitalopram (Lexapro), although dozens of others exist.

In some cases, the medication may cause side effects, or it may not alleviate your symptoms. For others, symptoms may be only temporarily reduced. When symptoms return a short while later this is referred to as chronic or recurrent depression.

How Depression Can Become Treatment-Resistant Depression

When standard treatments fail, depression may become treatment-resistant depression. Research published in Patient Preference and Adherence found that anywhere between 10-30% of patients dealing with depression show partial or no improvement with depression treatment. There are several factors that can contribute to TRD, such as:

  • Medication adherence, or whether or not you take the medication as prescribed
  • Age
  • Misdiagnosis
  • Genetic factors

Drug-Gene Interactions

There are certain genes that can affect depression treatment. For example, research published in the Journal of Psychiatry & Neuroscience found that some genetic variants in serotonin transporter-serotonin receptors affect how the body responds to SSRIs. These genes can affect the probability of response in TRD.

Further research published in Clinical Pharmacokinetics found that variations in the gene CYP2D6 can affect the way people metabolize antidepressants. In some cases, the body may have too little or too much to help combat the symptoms of depression.

Finally, one study published in The International Journal of Neuropsychopharmacology discovered that variation in other genes like GRIK4, BDNF, SLC6A4, and KCNK2 may also be associated with the development of treatment-resistant depression.

Your genetic profile can affect how your body responds to or processes medications, and not every medication will work the same for everyone.

Drug-Drug Interactions

Medications prescribed for preexisting conditions can also affect depression treatment. Other prescriptions, whether for a physical or mental health concern, may interact when taken with depression medication. Sometimes the medications have overlapping side effects and in other cases, one drug may interfere with the metabolism of the other drug. This can lead to higher or lower amounts of the drug in the body than expected. Before starting a new medication to treat depression, it is important to learn more about any possible drug-drug interactions.

What to Do About Treatment-Resistant Depression

Remember that “treatment-resistant” does not mean there is no treatment for your depression.

Treatment-resistant depression simply means that you have failed 2 or 3 or several medications and may need to explore other options. You may require a different medication, a different dosage, or a combination of medication(s) and other treatment options. If you find your symptoms are not improving with your currently prescribed medication, talk to your primary healthcare provider about it.

Consider Pharmacogenetics

Pharmacogenetic testing (PGx) examines specific gene variants that may influence the efficacy and tolerability of medications prescribed to treat your depression. This genetic testing for depression medication is often used in patients who have experienced treatment resistance and some research shows that these might be the people best suited for this type of testing.

Genomind’s pharmacogenetic test looks at 24 genes related to mental health treatment, including treatment options for TRD. It provides guidance across 10+ mental health conditions and 130+ medications to help clinicians determine:

  • Which medications may be more likely to be effective
  • Which medications may be more likely to have side effects
  • How you metabolize medications for personalized dosing guidance

The Genomind PGx test can be done at a clinician’s office—or from the comfort of your home. It requires a prescription, and Genomind can help connect you with a verified Genomind provider near you. Get started by filling out this form.

Is Your Treatment Working for You?

With genetic testing for depression, your clinician can develop a more personalized treatment plan for you. Although PGx testing is only one piece of the treatment puzzle, it is an important one. Understanding your genotype can help your clinician better understand medication options that are specific to you. A testament to this – Genomind PGx test-taker Kristen shared how she overcame treatment-resistant depression in My Depression Story.

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