Treatment resistant depression

What is treatment resistant depression?

In Australia, treatment resistant depression (TRD) is defined as major depression that does not improve after trialling 2 or more medications.

Why are other treatments needed for people with treatment resistant depression?

Treatment beyond initial trials of antidepressants and talk therapy sometimes requires psychiatrist referral, and involves options such as combining medications or prescribing electroconvulsive therapy (ECT).

Why is treatment resistant depression challenging to manage?

When conservative treatments, such as talk therapy, social and lifestyle changes and antidepressant medications, do not result in satisfactory improvement in depression symptoms, treatment becomes more difficult. 

In treatment resistant depression: 

  • Symptoms become harder to treat with each subsequent medication tried 
  • The likelihood of symptoms completely resolving, or even reducing, becomes less likely 
  • Recurrence of symptoms becomes more probable 

TMS may be preferable to more medication

Some people may experience intolerable side-effects to antidepressants or have conditions where these side-effects are unacceptable or too risky.

Some antidepressant medications may cause weight gain, sexual problems, nausea, or fatigue. TMS may be a more desirable option for these people.

It is common to continue taking antidepressants while receiving TMS. TMS may be a better alternative to trialling new or additional medications.

TMS has less side-effects than ECT

Some people with certain types of severe depression may consider electroconvulsive therapy (ECT), which requires anaesthetic.

ECT is designed to induce seizures and is commonly associated with memory problems.

TMS has comparable effectiveness to ECT,4 without the same side effects or anaesthesia. This is because TMS uses magnetic currents to change brain activity in a few connected brain regions. This is in contrast to the wide-spread application of electrical currents in ECT that changes activity all over the brain.

  1. Thomas, Laura, et al. “Prevalence of TRD in primary care: cross-sectional data.” British Journal of General Practice 63.617 (2013): e852-e858.
  2. Mrazek, David A., et al. “A review of the clinical, economic, and societal burden of TRD: 1996–2013.” Psychiatric services 65.8 (2014): 977-987.
  3. Wiles, Nicola, et al. “Management of treatment-resistant depression in primary care: a mixed-methods study.” British Journal of General Practice 68.675 (2018): e673-e681.
  4. Papadimitropoulou, Katerina, et al. “Comparative efficacy and tolerability of pharmacological and somatic interventions in adult patients with TRD: a systematic review and network meta-analysis.” Current medical research and opinion 33.4 (2017): 701-711.