Alternate Options for Treatment Resistant Depression

[Arinya]

Hey, I’m new here so hopefully this all falls within the guidelines :’) (and do let me know if it doesn’t)

I’ll try my best to keep this short so as to not overwhelm anyone with too many words. I’ve had a long-standing battle with severe MDD, of which different medications has barely touched alongside psychotherapy and other supports like outreach services, in-patient, youth residential recovery programs, so on and so forth. I’m still in such an incredibly dark space, and in a constant state of distress, which sucks because I recognise the value of the psychological support and can intellectually pick my way through every one of my thoughts, but can’t ever manage to ease the great pain that drives me to pursue some, uh, not-so-safe decisions, to put it lightly.

Anyways, a psychiatrist I saw earlier this week wants to explore some of the more modern treatments in the hopes it allows me to respond better to all the psychosocial/therapeutic supports I have. I guess I’m a bit afraid, both of the unknowns and difficulties making such big decisions along with the deep seated hopelessness that has no faith in anything helping. I’ve done so much research and consulted my psychologist, gp, and a friend who’s been through some of these treatments, but I don’t know what to take into consideration, what to beware of, if this is even worth pursuing. I hope somebody can help 🙏🏻

[sbella02]

Hey Arinya,

Thank you so much for reaching out here, welcome to the forums. I'm sorry to hear about what you've been going through with your MDD. 

If some of those not-so-safe decisions start to creep back in at any point, just know that there are always resources like Lifeline that are available to help support you through those thoughts. You can reach them 24/7 on 13 11 14.

I want to direct you to a few previous threads that may be helpful for you:

Treatment resistant depression (post from 2024 by Sad57)

Treatment Resistant depression (post from 2022 by Smidgen)

Treatment-resistant depression (post from 2016 by Zoostar84)

If you head up to that search bar at the top (should be next to notifications) and type in "treatment resistant depression", there's a bit of a goldmine of similar posts where people share their experiences, which may be good to have a look through.

Otherwise, feel free to keep chatting with us if you'd like, we're here to help support you. 

Take care, SB

[therising]

Hi Arinya

I'm wondering whether anyone who's helping you knows exactly what's causing or keeping you in the depression. My heart truly goes out to you in regard to exploring a huge variety of possibilities that may help. When it comes to the 'trial and error' aspect of treating long term depression, unless someone's experienced it for themselves they can't relate to how depressing the 'error' side of that becomes. Kinda like 'Okay, we keep finding what doesn't work'. This definitely creates a depressing sense of hopelessness, leading to the belief that nothing will work.

Such a huge variety of things can lead us into a depression and unless the exact cause or causes are known, we can end up being treated for everyone but the thing that's causing it. If the root cause is purely biological or chemical and we're receiving psychological treatment, the true cause may not be addressed. If the cause is mentally based, it may always remain even if we're taking a med (chemistry in tablet form) unless perspective or mental factors can be altered while on that medication. If mental factors, such as depressing belief systems and depressing inner dialogue, aren't altered the depression returns. If the issue's naturally soul destroying, treatment that speaks to the soul can be the way to go for some folk (spiritual or psycho spiritual counseling). The 'Dark Night of the Soul' factor can resonate for some. For some people, addressing all 3 areas ends up being what helps (biological/chemical, mental and soul based). In this case, it's not about addressing a single depressing factor, it becomes about addressing what is a recipe for depression, with a number of ingredients involved.

Do you have any sense of what could be the root cause/s of the depression you're struggling with? Putting aside what everyone else believes it is or may be, what do you feel it could be?

[Arinya]

I know the causes/roots of the pain and for the most part it is psychological (traumatic childhood, deeply held self beliefs etc). The problem is that the recommended lines of therapy (CBT, DBT, soon to try ACT) don’t work for my mind because I can detail every single cognitive bias and identify cognitive dissonance, recognise those root causes and why I feel different things, but I can never actually tap into the feelings and watch them change. So they want to try some of the more psychiatric medical treatments to give my brain more of an opportunity to create those new neural pathways and start to feel different. 

I don’t know if that made any sense, apologies, but I fully get where you’re coming from and agree that there’s so many different factors influencing each individuals’ experience.

[Arinya]

Thank you so much for this; I will have a look at the other discussions listed.

[Optical1]

Hi

Have you tried any medical treatments in the past?

What was your experience with them? This might be influencing your decision making now.

I have had multiple treatments and medications and other therapies over the past 25 years. 

It's ok to "trial" something...just because you try it doesn't mean you're on it forever...and you always can consent to treatment and stop it if you need to. Hopefully your doctors can work with you and keep evaluating the treatment as you go along. 

Doing something new is always a bit scary but could also give you some relief or help that you've not had yet.

[Arinya]

I won’t go into detail but I’ve been on multiple different medications under clinical supervision that have not helped (along with a lot of psychotherapy). Hence the psychiatrist wants to explore some newer non-medication treatment forms but I’m struggling to know what to base my final decision on because they are newer meaning less research and because it’s a heck of a lot of money for someone so young. The stats and reports in funding seem quite promising but it’s hard to know what’s true and what/how things might go wrong.

[Eagle Ray]

Hi Arinya,

I can relate to what you say about being able to see the cognitive biases, identify the cognitive dissonances and recognise the root causes and related feelings, but not being able to tap into the feelings and watch them change. I was stuck like that for a long time and I found years of talk therapy did not substantially shift the stuckness. I found approaches such as CBT did not help me. I essentially already understood what CBT taught, so doing it as a therapy didn't add anything or change anything because it was the organic shift in the body that needed to happen that wasn't responding to a top-down cognitive restructuring approach.

After years of just trying to get through I started researching somatic-based therapies and the autonomic nervous system. I read a book by Peter Levine called In An Unspoken Voice: How the Body Releases Trauma and Restores Goodness. He describes the method he has developed called Somatic Experiencing. This resonated and made huge sense for me. I sought out practitioners of this method and the first few I tried were not a good fit. Eventually I found someone who was and I have made so much more progress at actually resolving trauma and feeling different. My current psychologist has helped me reconnect with being able to sense and feel into myself and then work intuitively with that so that long held stuck memories and autonomic nervous system states and responses begin to release and resolve. It has been a work in progress because like you I had issues relating to a traumatic childhood and deeply held self beliefs, and those things don't resolve overnight. But I can say they are on a pathway to resolution now and I've made significant progress.

In mentioning that particular therapy I am not suggesting that is necessarily the right one for you. I'm just sharing an experience in case it helps in any way at all. That approach is a gently titrated one, designed to go gently and not overwhelm the nervous system, and I think that's important when doing somatic work. Another thing that may help is looking at Stephen Porges' Polyvagal Theory which is a model for understanding how the autonomic nervous system handles trauma.

For me I had to move away from approaches that were more mental in nature and start from the body. I actually think the more cognitive approaches can be really helpful but I think for some people they need to experience the bodily shifts first, to actually know through feeling how trauma can resolve. However, I think it is essential with doing any somatic work to be working with someone trauma-informed and most importantly someone you trust and feel really safe with. My experience with the earlier therapists I tried to do somatic work with was that my body would not let go in their presence because they just weren't the right fit for me. When I found my current psychologist, I quickly processed a stuck trauma in just the second session. A sense of safety is necessary including a feeling of co-presence or co-resonance with the therapist. This co-regulation is actually how the change is made possible.

When it comes to treatment resistance, there can also be other interfering factors. For me one has been hormonal dysregulation now that I am in perimenopause, but women can experience such dysregulation at all stages of life. So sometimes something like that can be interfering too but isn't always considered by a person's mental health team. I have come to realise that in my case early trauma has caused autonomic dysfunction, hormonal dysfunction and immune dysfunction (manifesting in autoimmune disease). So I've really learned everything is connected and I couldn't treat anxiety and depression in isolation.

Those are just thoughts rather than advice, in case they are helpful in solving the puzzle of how to break through the treatment resistance.

All the very best,

Eagle Ray

[therising]

Hi Arinya

What you say makes absolute and complete sense. To be so highly conscious of everything yet still not be able to tap into certain feelings leads frustration to sound like an understatement.

Having once heard 'emotion' defined as 'energy in motion or e-motion', we gotta be able to feel the energy to experience it. If we can't feel the chemical energy of dopamine, we can't experience it as exciting. If we can't feel the side effects of high and energetic levels of oxytocin and the beliefs that help promote it, we're not going to feel what love feels like. I can understand why certain people participate in extreme sports or high risk activities. Unless they're doing and feeling something extreme, they can't feel much at all. So many different reasons for why some folk feel so much and others struggle to feel much at all, especially with trauma involved.

While Eagle Ray has graduated to such an impressive level of self understanding and self development, I imagine you can relate to the incredible amount of hard work that takes. While people can spend a part of our life bringing us down in so many ways, intentionally or unintentionally, it takes amazing kinds of people to raise themselves through, above and beyond all that (through years of hard work). So many on the forums here who are moving through that journey. I hope Eagle Ray offers you the inspiring guidance you're seeking, while coming from their own experience of trial, error and success.

[Arinya]

Eagle Ray and TheRising

Thank you. In terms of hormonal imbalances we’ve extensively ruled out any physical causes so it’s really just complex trauma and severe depression. It is certainly an understatement to say that it is hard work, though I appreciate the suggestions on different therapy modes targeting trauma held within the body rather than trying to unravel the impacts on the mind. It’s a lot to think about. I hope you’re both in a better place now; it sounds like it’s been a long road.