Coping With Treatment-Resistant Depression

If you’ve been diagnosed with treatment-resistant depression, you may be feeling defeated by connotations of the phrase “treatment-resistant.” However, it does not mean that you will never find a treatment that works—you just haven’t found it yet. A diagnosis of treatment-resistant depression may actually open up more doors for you as far as treatment.

And while different medications, psychotherapy, neurotherapeutics and other treatments may ultimately be effective, some of the most important approaches for depression include consistent self-care and self-compassion. This includes letting loved ones who want to help you do so when they otherwise might be worried about saying or doing the wrong thing.

Read on to find some of the ways that you can cope with treatment-resistant depression emotionally, physically and socially, as well as tips for those wanting to help loved ones.

Coping Emotionally With Treatment-Resistant Depression

Hearing that your depression is treatment-resistant may bring with it its own set of feelings and responses. You may be blaming yourself, feeling like if only you could cope better, or do the right thing, you wouldn't be feeling this way—but you ARE doing the right thing. You're taking care of yourself the best way you know how as you look for a treatment that does work for you.

You may be feeling hopeless right now and wondering what’s left to treat you, but the good news is that you haven’t found the right treatment for you yet. Feeling hopeless is not a failure on your part—it is intrinsic to the disorder of depression. This is an exciting time in depression research, with many types of treatments beyond the SSRIs you have probably tried.

Another way to cope with treatment-resistant depression is through mindfulness. Detaching yourself from both thoughts of the diagnosis itself as well as the depressive thoughts may bring you some relief. Research shows that Mindfulness-Based Cognitive Therapy may prevent depression relapses by decreasing rumination, enhancing self-compassion, and increasing self-acceptance.

Coping Physically With Treatment-Resistant Depression

If you’re reading this and you have treatment resistant depression (TRD), there are likely physical things you're feeling such as fatigue, but did you know that all of the below are symptoms of depression too? It is important to note that both pain and depression work on the same neurologic pathway. Working on some of these physical symptoms may also help you cope with your depression.

Physical Symptoms of Depression

• Joint pain
• Limb pain
• Back pain
• Gastrointestinal problems
• Fatigue
• Trouble sleeping (too much or too little)
• Moving faster or slower than usual
• Appetite changes 

Because of depression, probably the last thing you want to do is exercise. You may have low energy and wonder how you could possibly spare any of that energy. Paradoxically, being active can create more energy.

It is thought that exercise can be helpful for depression symptoms because it stimulates neuroplasticity, reduces inflammation (thought to be a key marker/correlation in TRD) and increases resilience to oxidative and physiological stress. Additionally, it promotes self-esteem, social support and self-efficacy.

You don’t need to run a marathon, just start by moving five minutes more than you did yesterday and build up. In fact, moderate exercise may be more effective long-term for TRD than high-intensity exercise that takes longer to recover from.

While you might want to throw something at anyone who asks if you’ve tried yoga—it may at least be worth a try if you haven’t tried yet. It won’t cure your depression but a meta-analysis (analysis of several studies) shows that it may reduce depressive symptoms, perhaps because of the combination of exercise and mindfulness.

One key benefit to exercise for coping with treatment resistant depression is that you may start feeling at least small benefits immediately, which can be helpful while you’re waiting for a new medication to kick in. Research shows that even a single session had effects, increasing atrial natriuretic peptide, brain natriuretic peptide, and copeptin—hormones that may help regulate mental health.

Physical Therapy

Chronic pain and depression often go hand-in-hand—sometimes depression may be fueled by the experience of being in chronic pain and sometimes depression is linked to pain that does not have a structural cause.

Either way, physical therapy has been shown to help reduce both pain and depression concurrently.

Nutrition

You may not realize this, but food and our mental health influence each other in many ways. For example, changes in eating habits (either eating significantly more or significantly less) is one of the symptoms of depression. Additionally, a diet lower in nutritious foods may increase inflammation, which is linked with depression.

Research shows that many people with depression are relatively low in vitamins/minerals such as omega-3s, folate/Vitamin B and magnesium and that incorporating foods with these nutrients into your diet may be helpful.

Even if you don't feel like you have the capacity for major diet changes, there are still smaller changes you can make, such as eating breakfast and limiting fast food, sodas, fried and highly processed foods.

Coping With Treatment-Resistant Depression Socially

Social support is a protective factor against depression. It can help people both emotionally and logistically manage the load of things piling up because of depression. Plus, knowing you are positively impacting others in this world can help give your life more meaning.

When people feel depressed, they often feel incredibly isolated and alone in their experiences, and finding community through support groups, online communities, and/or patient advocacy organizations can help them feel less alone. Many are online, which can be a bonus if you're having a hard time leaving your house.

Local In-Person Support Groups

One of the advantages of face-to-face support groups versus online groups is accountability and honesty—it's harder to fib face-to-face for most people. Additionally, in person, you gain the verbal cues that are harder to discern online. Below are several ways to find groups in your area.

• National Alliance on Mental Illness (NAMI) Connection: NAMI Connect is a program that the National Alliance on Mental Illness offers people dealing with mental health conditions to connect with each other and offer support.
• Psychology Today: Searching Psychology Today for support groups is one of the easiest way to find groups in your area. You can search by area and then filter by depression.
• 12-Step Meetings: Many people value the built-in community that 12-step programs provide. If you have problems with alcohol, Alcoholics Anonymous may be a good option for you. However, 12-step programs aren't just for alcohol or other substances. There are groups for other issues such as codependency, overeating and more. Specific to depression, there are groups for Depression Anonymous and Emotions Anonymous.

Online Synchronous Support Groups

Some support communities online may be asynchronous, meaning they are similar to a forum or a social media site where you may be responding to something someone has said hours or days ago. The following groups are all synchronous and via video chat, though, of course, you have the option of turning video off.

• Depression and Bipolar Support Alliance (DBSA): The Depression and Bipolar Support Alliance offers peer-run online support groups. Though the groups are hosted online, you can search by your local area.
• Sesh: Sesh is an online support group service offering support groups run by licensed therapists on depression, self-esteem and relationship issues, among other topics.

Support Communities

Health Unlocked: This site is a social networking site for people experiencing any health condition—including depression. Larger organizations, such as the Anxiety and Depression Alliance of America, also host their own groups on the site.

Reddit: For those who have written off the site for too nerdy or for fear of trolls, they will be surprised to learn that Reddit actually has thriving mutual support communities, especially around medical and mental health conditions. The depression subreddit has nearly one million members discussing depression, so you're never alone.

Mental Health America: This non-profit, which promotes mental wellness, hosts a support group and community board to support those with depression and other mental health conditions.

Caregivers

If you are reading this as a caregiver or a loved one for someone with depression, you may feel hopeless yourself wondering how you can help your person. You're probably afraid of saying or doing the wrong thing, because the last thing you want to do is make them feel worse when their emotional state is already a little fragile right now. Here's a few ways you can help.

Sometimes even the smallest tasks—like brushing teeth or taking a shower—can feel insurmountable to someone dealing with treatment-resistant depression. It can be helpful to offer assistance with household tasks like doing the dishes or grocery shopping.

Be mindful of the language you use around your person: words matter and your person is likely already being mean to themselves in their head and self-stigmatizing. Using person-centered/person-first language such as “a person with depression” rather than “a depressed person” helps remove depression as their identity.

Taking care of yourself may come in the form of setting boundaries or going to a caregiver support group such as the NAMI Family Support Groups (which aren't just limited to family—they may include significant others and/or friends) or DBSA's Friends and Families groups.

Importantly, caregivers/loved ones should know that while they may be eager to help, it can be challenging when they're not seeing a loved one with depression get better as quickly as they would hope. It often takes patience and persistence to improve with treatment resistant depression.