Options for Hard-to-Treat Depression

Depression is not one-size-fits-all…it is individual to each person it affects.

The same goes for medications, therapies and treatment plans. Finding what's right for you may take time. It's important to talk to your healthcare professional to determine which treatment plan may be right for you.

Some of the most common treatment options for hard-to-treat forms of depression are:

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Commonly known as “talk therapy,” psychotherapy is a confidential conversation with a trained healthcare professional to explore your thoughts, feelings, experiences, relationships, and behaviors. From there, the provider can help identify patterns, make connections, and help build coping skills to combat depressive feelings.1

  • Although depression is a disease of the brain, things happen in our lives that are out of our control and may feel triggering in the moment or later.
  • Talk therapy for depression can help you process these stressors and identify destructive or triggering behaviors.
  • For more information on where you can find an LGBTQ+-friendly healthcare professional in your area, click here.


There are many types of antidepressant medications available, most of which are in pill form. They are believed to work by increasing certain chemicals in the brain, such as serotonin, norepinephrine, and/or dopamine, by blocking the reabsorption of those neurotransmitters in the brain that are believed to regulate mood and relieve depression.2 In other words, these medications can help reduce feelings of sadness or depressed mood.

  • Like any medication, oral antidepressants have individual risks and benefits. They're also not a cure and often work best as part of a complete treatment plan.
  • Most antidepressants take a few weeks to kick in before people begin to feel the effects, so it's important to keep track of how you are feeling.
  • For more information on specific oral antidepressants, click here.
  • Adding another medication to an antidepressant may enhance its effects. Your doctor may recommend combining two antidepressants or adding medications like a mood stabilizer, which can help treat depression that lasts for a long time, goes away and comes back, or isn't treated well enough with an antidepressant alone. Some providers may also suggest adding an antipsychotic medication.3
Medication pills in a person's hand
For some people, depression symptoms persist even after being treated with multiple medications. Fortunately, there are other options for adults with these harder-to-treat forms of depression.
Two people having a discussion

Electroconvulsive Therapy (ECT)

Electroconvulsive therapy (ECT) is a procedure where small electric currents are routed through the brain in a controlled way to trigger a brief controlled seizure. This procedure affects neurons and chemicals in the brain, which allows for more communication between neurons in a certain area of the brain known to respond to antidepressant drugs. It can take a series of ECT treatments to relieve symptoms of severe depression.4

  • People who have ECT are put under general anesthesia and wake up 5-10 minutes after the procedure. They can resume normal activity in about an hour.
  • Typically, people need between 4-6 treatments before they feel major improvement, in some cases followed by once a month or once a year treatment over many years.
  • For more information on ECT for depression, click here.

Transcranial Magnetic Stimulation (TMS)

Transcranial magnetic stimulation (TMS) is a noninvasive procedure where a large electromagnetic coil is placed against a person's scalp. During a TMS session, a magnetic field is created to stimulate neurons in the brain through short pulses targeted to certain areas of the brain believed to control mood and improve depressive symptoms. Several sessions are typically needed over a series of weeks.4

  • The doctor will determine the amount of magnetic energy needed during the first TMS treatment.
  • Each session lasts about 40 minutes and does not require general anesthesia, so the person is awake during the procedure.
  • For more information on TMS for depression, click here.
Doctor discussion with a patient

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