According to the "Psychiatric Clinics of North America", treatment resistant depression is a term used by psychiatrists to describe depression that has not remitted with several trials of antidepressants, despite giving these at the recommended dose for at least 6 to 8 weeks. Causes include previously unidentified underlying medical conditions, such as low thyroid hormone. Causes include underlying psychological or social reasons. A more accurate term for this condition would be medication resistant depression.
Borderline Personality Disorder
According to "Kaplan and Sadock's Comprehensive Textbook of Psychiatry", Borderline Personality Disorder, or BPD, is a lifelong disturbance in regulating mood and maintaining relationships. People are seen as either good or bad. Small insults feel like huge blows. Mood is at times angry, often depressed. Self-harm proves common and sufferers often function below the expected level. Faced with a severely depressed patient, the psychiatrist must differentiate between depression on its own and an underlying personality disorder. The treatment for Borderline Personality Disorder is psychotherapy. Most commonly used treatments include Psychodynamic Psychotherapy and Dialectical Behavioral Therapy. Medications can temper the affect, leveling out the mood, but will unlikely bring improvement on their own, certainly not long lasting improvement. BPD, therefore, often proves a common cause for medication resistant depression.
Post Traumatic Stress Disorder
Many insults can lead to psychic trauma. The most common include childhood sexual abuse and war trauma. Women who've been sexually abused, especially early in life, are likely to develop depression later on. Depression can be the sole symptom or it may indicate that she also suffers from post traumatic disorder. As explained in "Kaplan and Sadock's Comprehensive Textbook of Psychiatry", symptoms of PTSD include depression, a hyper alert state, nightmares and obsessive thinking about the trauma. PTSD is difficult to treat. Medications treat various symptoms, including depression, but medications on their own will rarely suffice. The patient may need a safe therapeutic environment, such as long-term individual therapy, where over time she can improve as she learns better coping skills and becomes less overwhelmed by the trauma.
Situational Causes
Real life difficulties often precipitate depression. Common examples include stressful or abusive relationships, medical illness in oneself or in a loved one, difficulties at work, economic hardship and dissatisfaction with one's course in life. Treatment with antidepressant may prove futile if the underlying reason is not addressed. Psychotherapy can help identify the causes of depression and help the patient find ways to either make changes in their life or at least tolerate her difficulties.
References
- "Kaplan and Sadock's Comprehensive Textbook of Psychiatry"; Virginia Sadock and Pedro Ruiz (editors); 2009
- Journal of Clinical Psychiatry; Management of treatment-resistant depression: psychotherapeutic perspectives; Thase ME et al.; 2001;62 Suppl 18:18-24.
- Psychiatric Clinics of North America; Definition and Epidemology of Treatment-Resistant Depression; Fava M. and Davidson K.; June 1996
