7 Things to Consider When Your Depression’s Not Getting Better
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Several years ago, I had recurring bouts of depression that would come out of the blue — my mood and energy would plummet, my sleep would fall apart, I was self-critical, and my brain was clouded.
I didn’t understand why behavioral therapy wasn’t stopping or preventing the symptoms. I had always found that approach helpful in the past, and as a licensed psychologist had seen it help many of the therapy clients I worked with in my clinical practice.
Many people find themselves in a similar situation where depression treatments that have been shown to work in research studies — such as psychotherapy or medication — don’t relieve their symptoms.
Sometimes that’s because of an underlying physical health problem that can mimic depressive symptoms. In other cases, it may be treatment resistant depression (TRD), according to Mayo Clinic. Most research studies define TRD based on not being helped by antidepressant medication, but a review concluded that treatment resistance can include nonresponse to psychotherapy.
Unfortunately TRD is not at all uncommon. An overview of existing studies found that about 33 percent of people with depression continue to have significant symptoms after treatment with medication, and a meta-analysis of 101 studies showed very similar results for psychotherapy.
Some individuals find a combination of medication and therapy to be more helpful, but many continue to have symptoms. For example, one large study found that medication alone helped nearly 66 percent of participants and medication plus therapy helped about an additional 9 percent.
If your depression has persisted even with an evidence-based treatment, there are several options that could help provide the relief you need.
1. Get a Physical
Mood, energy, and mindset are intimately tied to physical health, and an identifiable physical illness could be the cause of your depression, according to Mayo Clinic.
In my own case, I finally found a physician who realized my symptoms might be a sign of untreated chronic Lyme disease, especially since Lyme infection is very common where I live in southeast Pennsylvania. Untreated Lyme disease can cause symptoms that mimic those of depression.
Blood tests confirmed his suspicion, and medical treatment for Lyme disease put a stop to the depressive episodes I was experiencing.
RELATED: Why Lyme Disease Gets Misdiagnosed as Depression, Bipolar, and More
2. Try Tweaking Your Diet
I’ve often found in my clinical practice that people feel annoyed if I tell them that their mental health symptoms might be related to diet. But numerous studies have confirmed that the things we eat and drink can have serious effects on depression.
For instance, a recent study showed that consuming higher amounts of ultraprocessed foods (such as sweets, certain packaged foods, and artificially sweetened beverages) is linked to an increased risk of depression. A systematic review and meta-analysis of 41 studies showed that eating a low-nutrition diet (such as a diet high in sugar and low in vegetables) raises the risk of depression by as much as 50 percent.
Multiple studies have shown that improving diet can help manage depressive symptoms. One of the most rigorous studies compared the effectiveness of a nutritional program to a control intervention (social support) among people with depression. Participants in the nutrition group were more than 4 times as likely to experience remission of depression, meaning they had only minimal symptoms that did not significantly interfere with their lives.
Most studies recommend some version of the Mediterranean diet, a mostly plant-based eating pattern that emphasizes whole grains, vegetables, fruits, beans, spices, herbs, nuts, and olive oil, along with fish and seafood twice a week and moderate amounts of eggs, poultry, and dairy.
It’s often easiest to shift your diet when you make small changes that build gradually over time. For example, try to replace one sugary dessert with a piece of your favorite fruit, have hummus at lunchtime in place of meat, or put olive oil instead of butter on your vegetables. It could also help to reach out to a registered dietitian for guidance.
RELATED: Depression: 6 Tips for Eating Well When Cooking Feels Impossible
3. Try Behavioral Activation
One of the most effective treatments for depression is a form of cognitive behavioral therapy (CBT) known as behavioral activation, which I have found helpful myself.
Many studies have found that it can be highly effective — one meta-analysis of 26 studies concluded that behavioral activation is at least as effective as antidepressant medication. The treatment involves gradually doing more activities that bring a sense of reward, enjoyment, and accomplishment.
Doing things that are enjoyable makes it feel like life is worth living, and accomplishing goals (even small ones) boosts your self-efficacy. Behavioral activation also supports the neurotransmitter systems (such as dopamine, as research shows) that underlie a sense of engagement with life.
The activities in behavioral activation don’t need to be grand, which is good news if you’re struggling with low motivation due to depression. They can be as simple as taking out the trash or reading a couple pages from a magazine, for instance.
4. Talk to Your Doctor About Adjusting Your Antidepressants
If you are taking medication for depression, and it hasn’t brought you enough relief, consider talking with your doctor about a medication change. They might prescribe a different dose of the medication you’re on, or a different drug altogether. Research shows that even if one antidepressant is not helpful, a different medication could be.
Your doctor might also recommend adding another medication to your current antidepressant — an approach research studies have shown can be effective. Be sure to talk with your doctor about the pros and cons of any potential changes, such as increased side effects.
5. Look Into Mindfulness-Based Cognitive Therapy
Meditation and other mindfulness practices are helpful for more than relaxing and quieting the mind. Pioneering research has found that mindfulness-based cognitive therapy (MBCT) — a form of psychotherapy that combines CBT, meditation, and mindfulness — can offer relief for many people whose depression has not responded to other treatments.
For example, one large clinical trial among people with longstanding depression found that MBCT significantly reduced symptoms in more than 30 percent of participants — a notable finding given that the average study participant had had depression for nearly seven years.
6. Give Some Thought to Transcranial Magnetic Stimulation
Transcranial magnetic stimulation (TMS) involves placing a device against the scalp that delivers magnetic pulses of energy through the skull into areas of the brain believed to be involved in depression.
Many studies have shown that it can be effective for relieving TRD. One review of clinical trials for TRD that compared TMS to placebo found that individuals in the TMS group were more than five times as likely to experience remission of depression.
Talk with your provider about whether TMS could be helpful for you, as well as possible side effects (such as headache) and how to manage them.
7. Consider Finding a Ketamine Clinic
One of the most promising new treatments for depression is ketamine therapy. Ketamine is an anesthetic that can produce psychedelic experiences and hallucinations. Ketamine therapy (also known as “ketamine-assisted therapy”) is a mental health treatment that uses low doses of ketamine for conditions like TRD and may be combined with sessions with a psychotherapist.
A review of existing studies found that a single dose of ketamine can provide rapid relief from depression within 24 hours, but fades within a week. While the benefits of a single dose tend to be short-lived, taking additional doses at regular intervals (such as two or three times per week, under the supervision of a professional) can have more lasting effects.
Be sure to work with a qualified medical professional, given the risk of side effects and drug interactions. Important note: Taking ketamine recreationally is not the same as undergoing supervised treatment with a skilled professional. The American Society of Ketamine Physicians, Psychotherapists, and Practitioners provides a helpful guide on how to find a ketamine clinic. They also maintain a searchable directory of providers.
RELATED: I Tried Ketamine Therapy for My Depression — Here’s What I Learned
The Bottom Line
As I know from both personal and professional experience, depression can make everything harder — including the search for the right treatment. It can be especially dispiriting to continue to struggle even after investing time, money, and energy in the best treatments you can find.
If your symptoms persist, know that you are not the cause of your pain. TRD is not personal — it can strike anyone, and your ongoing struggles reflect not a deficit on your part but rather the nature of depression and the limits of existing treatments. Just because previous treatments have failed you doesn’t mean that different approaches will, too.
It can be hard to feel hopeful when you’re depressed, but there is still reason to hope.
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