There are cases when depressed people do not get any better even though they have been on treatment for a long period of time. Explore why this sometimes happens and what you can do about this problem.

If you have undergone medical treatment against depression but your symptoms haven’t fully got any better, you may have treatment-resistant depression. Drugs and psychotherapy work for more than half of the cases. But unfortunately, there is this treatment-resistant depression wherein standard treatments don’t help much or don’t help at all.

On this treatment-resistant depression, symptoms — such as feeling sad, hopeless and disinterested in activities — still linger despite medical attention. Or, in some cases, your symptoms improve only to keep coming back. Treatment-resistant depression can either be mild to severe, and generally requires trying a number of treatments to find out what can actually give better results.

Why is there treatment-resistant depression?

Similar to the rest of the forms of depression, treatment-resistant depression is most likely caused by a combination of inherited and environmental factors that affect brain chemicals called neurotransmitters. A lot of factors can contribute to treatment-resistant depression, and these can be:

Another mental health diagnosis. It’s not always easy to diagnose depression, and other mental health disorders may require different treatment. In particular, some forms of bipolar disorder are commonly misdiagnosed as depression if manic phases are mild. In many cases, depression occurs along with other conditions — such as panic disorder or post-traumatic stress disorder — which can make depression more difficult to treat. Ask your mental health provider whether your symptoms may be caused by bipolar disorder or linked to another mental health condition.

Not taking medications exactly as prescribed. Treatment may not work if you stop taking your medication, skip or lower a dose, or forget to take a dose. Many people get off track. This can happen for a number of reasons, including problems with side effects, thinking you don’t need medication or that you don’t need a full dose of medication because you feel better, or simply forgetting. If you do stop taking your medication, forget to take a dose or make other changes, be honest with your doctor about it so that you can address any problems and get back on track.

Emotional stress. If you’re feeling stress or anxiety because of situations in your life that aren’t getting better, medications alone might not help. Examples include relationship issues, financial problems or inadequate housing. In addition, childhood abuse or neglect can continue to affect you throughout adulthood. Psychotherapy can be especially helpful in coping with stressful situations.

Underlying health problems. Other medical conditions or illnesses can sometimes mimic or worsen depression. These include thyroid disorders, chronic pain, anemia, heart problems, anxiety disorders, and substance abuse or addiction.