What treatment-resistant depression means
Treatment-resistant depression is usually considered when an episode has not responded to at least two antidepressant trials given at an adequate dose for an adequate duration, with adherence confirmed. It is not simply depression that has lasted a long time.
Apparent resistance can have other explanations: the diagnosis may be wrong, the dose may be too low, side effects may have stopped consistent use, or another condition such as bipolar disorder, thyroid disease, sleep apnea, anaemia, anxiety, PTSD or substance use may be maintaining the depression.
Related: Psychiatry → · Dr. Ruja Shrestha profile → · All conditions →
The specialist review
The consultation reconstructs the mood history, previous episodes, medicines, doses, durations, response and side effects. Adherence, alcohol and drug use, sleep, pain, thyroid disease, anaemia and current stressors are reviewed.
Bipolar disorder, anxiety disorders, OCD, PTSD, ADHD and personality difficulties are screened because they change the treatment plan. Suicide risk and psychosocial safety are assessed directly.
- Confirm the diagnosis and check for bipolar features
- Review every previous antidepressant trial and dose
- Check adherence, side effects and drug interactions
- Screen for medical, sleep, anxiety, trauma and substance-use contributors
- Assess suicide risk and social support
Next-step options
Options include optimising the current medicine, switching to another antidepressant, adding a second medicine, or combining medication with structured psychotherapy. CBT can address negative thinking, avoidance, inactivity and the practical problems that maintain depression.
For selected patients, referral for electroconvulsive therapy, transcranial magnetic stimulation or ketamine-based treatment may be discussed where these services are available. These are not first-line treatments for everyone, and the benefits, risks and practical arrangements need careful discussion.
Access and booking
Appointments are at Mind Wellness Center, Durbar Marg area, Kathmandu. Call +977-9747736624 or use /book-appointment. Telepsychiatry is available for appropriate follow-up and for patients who cannot attend in person. This is not an emergency service.