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How depression turns into TRD

How depression turns into TRD

Depression is a difficult condition that affects many individuals. What is already a complex problem becomes even more complicated when depression turns into TRD, or treatment-resistant depression. How does depression turn into TRD, and what can be done to help patients with this condition?

Depression vs. TRD

What is depression and what is TRD? To begin, let’s look at how medical professionals define TRD. While there is no definitive consensus on the issue, most members of the psychiatric community consider depressive symptoms to indicate TRD when a patient:

  • Has not responded to two different oral antidepressants from different classes, or
  • Has tried four different treatments with no or little relief from depressive symptoms

While this is the clinical perspective, patients who think they may have TRD can ask themselves the following:

  • Do you feel as if your treatment has resulted in positive change or relief of symptoms?
  • Has your treatment created some change, but you still feel weighed down by your depression?
  • Are you experiencing too many side effects from your oral antidepressants?

Why do patients develop TRD? There are any number of reasons that may be involved. Factors triggering TRD can include age, sex and health. For example, women and seniors tend to experience TRD at higher rates.

Unfortunately, there may be a number of unknown factors involved as well. Research into what causes depression in general is ongoing, meaning that it may be some time before experts uncover the root cause of TRD and related conditions.

Diagnosing TRD

There is currently no concise and defined process for diagnosing TRD. Generally speaking, patients go through various treatment stages before receiving a diagnosis of TRD. It is a complex disorder that involves multiple primary and secondary triggers. A psychiatrist or your primary care provider may first address medication management and work with a patient to determine how and if an oral antidepressant is working. The psychiatrist may also recommend the addition of a second oral antidepressant.

Next, a psychiatrist may recommend alternate or supplemental forms of therapy. If a patient has been pursuing these interventions for several months and showing little improvement, a psychiatrist may diagnose the patient as having TRD.

Treatment options for TRD

If you have TRD, what are your options? Given that the name itself indicates that the disorder is resistant to treatment, patients may lose heart. There are, however, many forms of intervention that can help patients with this condition, including supplements to oral antidepressants, such as Spravato®, and somatic therapies.

Somatic Therapies

Non-drug therapies known as somatic therapies can be effective in treating TRD. One such option is TMS, or transcranial magnetic stimulation. This intervention targets the brain’s nerve cells in the region that affects mood. Another option is ECT, or electroconvulsive therapy (ECT), which is designed to induce changes in the brain’s chemistry.


Spravato is an esketamine nasal spray that is used increasingly to treat TRD. This medication is prescribed as a supplement to an oral antidepressant, providing patients with the additional support they may need to conquer treatment-resistant depression. This prescription medication has been shown to bring real results to patients with major depressive disorders, as well, making it a viable alternative for many patients with depressive symptoms.

If you believe that you may be experiencing TRD, don’t fear. You do have options available to you. Get in touch with your physician today to begin exploring your treatment options for TRD, including Spravato. With the right help and therapies, you can successfully treat TRD and experience relief from even the most stubborn symptoms.