Intractable means goes on for a long time. Intractable or Treatment-Resistant Depression or TRD is therefore usually defined as non-response to attempts at treating depression with an adequate dose for an adequate time of two or more anti-depressants and following a complete psychiatric assessment.
Not all anti-depressants are as effective as others, and they each suit different individuals. No anti-depressant treatment works in everyone and it is common for each individual patient to experience and tolerate the side effects in different ways. Almost two-thirds of patients still experience ongoing incapacitating symptoms after their initial treatment, and for some, it takes much trial and error to find a treatment which works. For other patients, initially successful treatment may fade in benefit with time, leading to a recurrence of their symptoms.
The management of TRD, therefore, requires a careful and detailed assessment, including the severity of your symptoms, ruling out any other possible causes of the depressive symptoms you may have. Careful consideration will also be given to alternative anti-depressants you could try and in what order, which are then carefully tailored to your needs by balancing benefit against tolerability. The place of talking therapies such as Cognitive Behavioural Therapy (CBT) will also be discussed with you as part of an agreed treatment plan, which may also include newer drugs, drug combinations or other additional therapies. The crucial factor is usually the selection of a treatment with minimal intolerable side effects, and which is done as quickly as possible, not only to relieve suffering, but also to prevent further worsening.
It is our belief that almost every person with depression can be helped eventually and hence no one should ever be dismissed as untreatable.
Intractable Depression, also known as Treatment-Resistant Depression (TRD), refers to depression that does not improve after trying at least two different antidepressants at adequate doses and duration. Unlike typical depressive episodes, TRD often requires a more specialised and multi-modal approach, including advanced medications, therapy, or neurostimulation.
You may have TRD if you continue to experience persistent symptoms, such as low mood, fatigue, sleep issues, and loss of interest, despite trying multiple antidepressants. A formal psychiatric evaluation is essential to confirm the diagnosis and rule out other contributing factors like bipolar disorder or underlying physical health issues.
There is no single cause, but TRD can result from genetic, neurobiological, and psychosocial factors. Some patients may not respond to standard treatments due to biological resistance, incorrect diagnosis, medication interactions, or co-existing conditions such as anxiety, ADHD, or personality disorders.
Yes, while TRD can be more complex to manage, there are many evidence-based treatments available. Options include medication adjustments, combination therapies, psychotherapy (like CBT), and, in some cases, novel treatments such as ketamine, rTMS, or esketamine nasal spray. Most patients improve significantly when the right approach is found.
If you’ve tried two or more antidepressants without significant improvement, it is advisable to consult a specialist in treatment-resistant mood disorders. Early intervention with a tailored treatment plan improves outcomes and reduces the risk of further deterioration or long-term disability.
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