Authors: Jan Jacobus Muit; Philip F P van Eijndhoven; Andrea Cipriani; Iris Dalhuisen; Suzanne van Bronswijk; Toshi A Furukawa; Henricus G Ruhe · Research
What Are the Best Next Treatment Steps for Depression That Hasn't Improved?
A comprehensive review of treatment options when initial depression therapy hasn't worked, examining which approaches may be most effective.
Source: Muit, J. J., van Eijndhoven, P. F. P., Cipriani, A., Dalhuisen, I., van Bronswijk, S., Furukawa, T. A., & Ruhe, H. G. (2022). Efficacy and acceptability of next step treatment strategies in adults with treatment-resistant major depressive disorder: protocol for systematic review and network meta-analysis. BMJ Open, 12, e056777. https://doi.org/10.1136/bmjopen-2021-056777
What you need to know
- Depression treatment often requires trying different approaches when initial treatments don’t work
- There are many next-step treatment options, including medication changes, therapy, and brain stimulation treatments
- Understanding which treatments work best for whom can help guide better treatment decisions
The Challenge of Treatment-Resistant Depression
Have you ever tried treating a health condition, followed all the recommendations, but still didn’t get better? This is a common and frustrating experience for many people with depression. While there are effective treatments available, finding the right one often involves some trial and error. Depression affects over 163 million people worldwide, and many don’t respond fully to their first treatment attempt.
Understanding Treatment Resistance
When we talk about “treatment-resistant depression,” we mean depression that hasn’t improved despite trying one or more adequate treatments. But what counts as an “adequate” treatment? Generally, it means taking an antidepressant medication at a sufficient dose for at least 4 weeks. However, some researchers propose we should think about treatment resistance as existing on a spectrum - from those who haven’t responded to one medication to those who’ve tried multiple different approaches without success.
Treatment Options When Initial Approaches Don’t Work
When someone doesn’t respond to their first antidepressant, there are several possible next steps:
- Switching to a different antidepressant
- Adding a second antidepressant
- Adding another type of medication to boost effects
- Trying psychotherapy
- Using brain stimulation treatments
- Combinations of these approaches
Each option has its own benefits and risks. For example, switching medications might help avoid drug interactions but means losing any partial benefit from the first medication. Adding treatments may provide additional benefits but could increase side effects.
Complex Decisions Need Better Evidence
Currently, there’s no clear consensus on which approach works best in which situation. While many studies have compared individual treatments, few have looked at the big picture of how all these options compare to each other. Additionally, what works best might depend on how many treatments someone has already tried - a person trying their second treatment might respond differently than someone who has tried five previous treatments.
What This Means for You
If you’re dealing with depression that hasn’t improved with initial treatment, know that you have options. Work with your healthcare provider to:
- Ensure you’ve given current treatments adequate time and dosage
- Discuss the full range of available next-step options
- Consider your personal preferences and circumstances
- Monitor progress carefully with any new treatment
- Be patient - finding the right approach may take time
Conclusions
- Treatment-resistant depression is common and requires a personalized approach
- Multiple next-step options exist, including medication changes, therapy, and other treatments
- More research is needed to determine which approaches work best for different individuals