Treatment Resistant or Chronic Depression

Chronic depression or treatment resistant depressionWhat is Chronic Depression, Also Known as Treatment Resistant Depression?

Chronic depression, also known as treatment resistant depression, is a disabling condition that often requires specialized treatment to achieve good results.

  • Chronic depression refers to depression that has lasted two years or longer. Many people with chronic depression report the symptoms have been nearly lifelong.
  • Treatment resistant depression refers to depression that has failed to respond to two or three adequate trials of medication or psychotherapy. Many people have received treatment with multiple medications and combinations of medications.

The book, Treatment Resistant Depression: A Roadmap for Effective Caredescribes the burden of this condition well…

“Major depressive disorder (MDD) contributes to more disability and diminution of quality of life than almost all other diseases in the world. The treatment resistance associated with MDD is a significant reason for its huge burdens. Its public health dimensions are staggering—MDD afflicts more than 300 million citizens of the world at some point in their lifetime, and treatment resistance occurs in 30%–40% of those who are fortunate enough to receive care.

Treatment Resistant Depression (TRD) is painfully linked with suicides, broken marriages and relationships, job losses, bankruptcy claims, impaired physical health, stressed families, and financially strained health systems. An estimated 4%–5% of all Americans struggle at some time with TRD, and worldwide, treatment resistance in major depression is a key determinant of burgeoning health care costs. These individuals, their families, and their clinicians are joined in the businessman’s search for “some treatments out there that could make me feel the way I once did.” “

Our Approach to Treatment

Our approach to the treatment of people with chronic depression is based on the principles of the National Network of Depression Centers, and involves several key components: comprehensive assessment, combinations of medication and psychotherapy as well as other, newer, approaches to treatment, and an integrated and evidence-based approach to care.

This approach has worked for many patients who have seen many other mental health professionals in the past without success.

Comprehensive Assessment

Our assessment begins with a thorough review of past treatment and an assessment of all of the factors, biological, psychological and social, that may contribute to chronic depression. This includes a careful evaluation of potential medical causes of depression, including clinical laboratory tests, brain imaging, and genetic testing. In addition, we use the latest online technologies to predict response to medications, and to evaluate past trials of medications.

Access to the Most Effective Treatments

We use combinations of medications that are predicted to be the most effective based on our comprehensive assessment. We use ketamine infusion, transcranial magnetic stimulation and refer people for electroconvulsive therapy and vagal nerve stimulation, as appropriate. We have clinicians trained in the most effective psychotherapies for chronic depression. We also assess for health conditions, including dietary deficiencies, that may contribute to chronic depression and provide access to medical care and nutritionists as needed.

Integrated and Evidence Based Care

Our approach to treatment is to provide all of the treatments that have been shown to be effective in high quality research studies (evidence based care) and to scrupulously assess response to treatment (measurement based care).

Our goal is to deliver care as an integrated team, working closely together, and in close communication.

Contact Us

If this sounds like an approach to care that you would like to learn more about, contact us using this form.

For More Information

Getting Started

Ketamine for Depression; 2017

TMS Effectiveness Updated


Treatment Resistant Depression: A Roadmap for Effective Care. edited by Greden, John F., M.D., Riba, Michelle B., M.D., M.S., and McInnis, Melvin, M.D. Washington, DC, American Psychiatric Publishing, 2011, 364 pp.

Chandler GM, Iosifescu DV, Pollack MH, Targum SD, Fava M. RESEARCH: Validation of the Massachusetts General Hospital Antidepressant Treatment History Questionnaire (ATRQ). CNS Neurosci Ther. 2010 Oct;16(5):322-5. doi: 10.1111/j.1755-5949.2009.00102.x. PubMed PMID: 19769599.