What is depression and how do I know if I have it?

Everybody experiences periods of low mood in their lives.

Often this is caused by external factors – things happening in relationships, jobs, finance and broader lives all have an impact on our mood day-to-day.

Depression often does not have a clear external cause, and when people struggle with periods of low mood or sadness for longer than two weeks, it is important to see a doctor.

Periods of low mood in depression are often accompanied by a number of other symptoms that impact the way you live your life :

• a lack of interest in doing things that you used to enjoy
• low energy and changes in sleep
• changes in appetite
• finding it hard to concentrate
• feeling guilt or worthless
• questioning whether you have a reason to keep living
• Depression can be a very lonely and isolating illness, but it is very common in today’s society.

Up to 20% of people report feeling depressed at some point in their lives, and there are probably many more people who struggle with low mood but never reach out for help.

Getting seen by a doctor early can prevent symptoms from becoming entrenched.

How can I treat my depression?

There is a big variation in how severely people are affected by their depression.

Some people will respond to lifestyle changes such as improvements in diet, sleep, exercise and managing stress.

These interventions are all proven to improve mood regardless of whether someone has a diagnosis of depression.

When people have been struggling with low mood for a long time, the first treatment your GP will suggest is an oral antidepressant tablet, and help from a psychologist.

Psychological therapies such as cognitive behavioural therapy (CBT), acceptance and commitment therapy (ACT), and trauma-focused therapy help people to understand patterns in their thinking and behaviour and build new coping strategies.

Combining medication and therapy often provides better results than either approach alone.

What is Treatment-Resistant Depression (TRD)?

Unfortunately, only 1 in 3 people will find relief from the first antidepressant tablet that they try, and benefits can take several weeks or months to emerge.

Many people living with depression will try more than one antidepressant tablet over time, but the likelihood of a new medication being effective reduces after each unsuccessful trial.

When a patient has tried two or more different antidepressant medications for a period of time, and hasn’t found a meaningful improvement in their mood, they are classified as having “treatment-resistant” depression or TRD.

Treatment-resistant depression is a term that was coined in the 1970s, when the treatments available for depression were much more limited than they are today.

Having “treatment-resistant depression” does not mean that someone has depression that is untreatable.

It is simply used to explain that oral antidepressants haven’t worked, and it may be time to look at next step treatments for their mental health.

Why is Treatment Resistant Depression a Challenge in Mental Health Treatment?

Unfortunately, modern medical practice has not kept up with the advances in treatment for depression.

Often, patients are not given access to more information about what treatments are available to them and what is likely to work.

Depression is a biologically complex illness. It involves brain networks, stress hormones, immune signalling, and psychological patterns. When treatment focuses only on one aspect, improvement can be limited.

A more comprehensive assessment is often needed when depression persists despite standard treatment.

Pressure on the Australian health system has reduced the time GPs have to spend with their patients, and many patients never get referred to the specialist care they need in managing their depression.

Factors Contributing to Treatment-Resistant Depression

Depression is a complicated illness, and the causes for it are not fully understood.

1. Neurochemical Imbalance :

Other people have many different factors contributing to their ongoing low mood and the combination of these different factors make it hard to treat.

Research now suggests that depression is not simply a serotonin deficiency.

Brain circuit dysfunction, altered stress responses, and reduced neuroplasticity all appear to play a role.

2. Underlying trauma :

Early life stress, attachment disruptions, and traumatic experiences can alter how the nervous system responds to perceived threat.

In our clinic we often see patients who have been exposed to significant stress through work.

These patients include first responders, police, ambulance officers, defence force personnel and veterans.

Changes brought about by exposure to trauma can exist long after the original event.

In these situations, medication alone may not address the underlying drivers of depression.

3. Neuroplastic brain changes :

Neuroplasticity refers to the ability the brain has to form new brain pathways, changing the way that people think, feel and act.

Chronic stress can reduce the brain’s flexibility over time.

Effective treatments often work by increasing neuroplasticity and allowing new emotional patterns to form.

Unfortunately, if depression remains untreated for a long time the brain circuits which lead to low mood can become entrenched.

This makes chronic depression harder to treat.

Re-wiring the brain away from the long-term circuits which have been carved by depression is a feature of many of the new treatments which are effective in TRD.

4. Health conditions :

Underlying health conditions such as thyroid dysfunction, autoimmune illnesses, hormonal changes and effects of other medications can all contribute to depression.

Your GP will be able to rule out a number of these conditions by speaking to you about your systems and doing a comprehensive blood test.

Sleep disorders, vitamin deficiencies, chronic pain, and substance use can also worsen depressive symptoms.

Identifying and treating these contributors is an important part of holistic care.

Current Approaches to Managing Treatment-Resistant Depression

Many people with TRD have cycled through multiple antidepressants and different psychotherapy modules without meaningful, long-term improvement.

Some patients get a partial response to treatment, reducing the severity of their depression but not treating it fully.

Oral antidepressant medications also have side effects such as weight gain, tiredness, sexual dysfunction or emotional blunting which for some patients causes more harm than the benefit of the treatment.

Exploring Advanced Treatment Options for Treatment Resistant Depression

Emerging Therapies : An Overview of Alternatives

When antidepressant medications fail to treat depression, there are now a number of safe and effective options that patients are able to move onto using.

These treatments are generally delivered in specialist settings and involve closer monitoring.

They aim to target brain circuits more directly than oral medication alone.

Electroconvulsive Therapy (ECT) : When and Why It’s Used

Electroconvulsive therapy (ECT) is sometimes called ‘shock therapy’ and it causes the patient to have a controlled seizure event.

The ‘shock’ causes reorganisation of the brain circuits, alters the level or neurotransmitter chemicals, and helps to balance the body’s stress system responses.

For this reason, it is a very effective treatment for severe cases of depression and can produce very fast recovery for some patients.

ECT has been used since the 1940s and developed a bad public perception in the early days because the patients were given the treatment without an anaesthetic.

Today, treatment is given in very controlled settings within hospitals, while the patient is under a general anaesthetic.

It can cause headaches, memory loss and required hospital admission.

As such, ECT is generally reserved for severe depression, depression with psychotic features, or cases where rapid improvement is required for safety reasons.

Transcranial Magnetic Stimulation (TMS) : A Non-invasive Option

TMS uses magnetic pulses applied to specific areas of the brain involved in mood regulation. Unlike ECT, it does not require anaesthesia and does not induce a seizure.

Depending on response, patients may need from 20 – 45 individual treatment sessions.

Treatments are given five days a week over several weeks.

In Australia, there are some Medicare rebates for TMS treatment but most clinics charge an out-of-pocket fee which is often around $150 per treatment session.

Other Innovative Solutions in TRD Management

Research into depression treatment is expanding rapidly.

Newer approaches focus on brain network modulation, inflammation reduction, and enhancing neuroplasticity.

Access to these treatments often depends on referral to specialist mental health services like GoodMind.

Lifestyle and Brain Health in TRD

While lifestyle changes alone may not resolve treatment-resistant depression, they can support recovery.

Regular exercise, sleep stabilisation, social connection, and structured daily routine can all enhance treatment response and reduce relapse risk.

Working with Your Healthcare Provider for the Best Outcome

Creating a Personalised Treatment Plan for TRD :

Effective treatment requires reviewing what has been tried previously and understanding the full biological and psychological picture.

The Importance of Ongoing Monitoring and Adjustments :

Depression treatment is rarely static. Regular follow-up allows treatment plans to evolve and adapt over time.

Looking Ahead : The Future of Treatment-Resistant Depression

Research and Developments in TRD Management

Advances in neuroscience are improving our understanding of how depression affects brain circuits and stress systems.

This research is guiding the development of more targeted interventions.

Hope for the Future : What’s on the Horizon for TRD Patients?

Treatment-resistant depression does not mean untreatable depression. The range of available options continues to expand.

Navigating the Challenges of Treatment Resistant Depression

Recovery is rarely linear. Finding the right treatment approach may take time, but persistence and specialist input can improve outcomes.

 

How to Reach Out and What to Expect from Treatment

If depression has not improved despite multiple treatments, it may be time to seek a more comprehensive assessment. Accessing specialist care can open the door to additional options.