You’ve tried therapy. You’ve tried medication. You’ve tried getting more sleep, exercising, being social—maybe even reading all the right books. And yet, the heavy fog hasn’t lifted. If anything, it’s settled in deeper. When nothing seems to work, it’s easy to start wondering: Is this just who I am now?
If this sounds familiar, you’re not alone. What you’re experiencing may be what’s known as treatment-resistant depression (TRD), and while the name can sound intimidating, understanding it is the first step toward finding a new path forward.
What Is Treatment-Resistant Depression?
Treatment-resistant depression is typically defined as a form of depression that doesn’t improve after trying at least two different antidepressant medications. But the term isn’t limited to medication alone—it can also describe depression that lingers despite talk therapy, lifestyle changes, or other standard interventions.
Importantly, treatment-resistant doesn’t mean untreatable. It simply means your depression might need a different approach—one that gets to the root of what’s happening emotionally, psychologically, or even physiologically.
Why Some Depression Doesn’t Respond Easily
Depression is not a one-size-fits-all condition. There are many reasons why someone might not respond to typical treatment approaches:
Unresolved trauma or emotional wounding that hasn’t been addressed in talk therapy
Biological or hormonal factors that require medical attention
Mismatch between the therapy style and your emotional needs
Overwhelming internal self-criticism that blocks progress
Feeling unsafe or unseen in the therapeutic relationship
In an initial session, a new client shared that she felt like she was doing everything “right”—taking medication, showing up to therapy, trying to stay connected—but still felt numb, exhausted, and deeply stuck. That sense of helplessness is incredibly common in treatment-resistant depression, and it’s not a reflection of personal failure.
It’s also worth noting that medication can still play a role, even when it hasn’t worked in the past. Sometimes a different class of antidepressants, a combination strategy, or working with a psychiatrist who specializes in treatment-resistant depression can make a meaningful difference. Exploring therapy and medication together can often be more effective than either alone.
Therapy Approaches That May Help
No one approach works for everyone—but here are several therapies that have helped many people when traditional methods haven’t:
Internal Family Systems (IFS): Helps you explore and understand the different “parts” of yourself—especially the ones that carry pain, shame, or the urge to give up. Rather than trying to eliminate these parts, IFS helps you develop a relationship with them that’s rooted in compassion.
Experiential Psychodynamic Therapy: Goes beyond insight to help you feel the emotions that may have been suppressed for years. When emotions like anger, sadness, or fear are experienced and expressed in a safe setting, they often lose their grip.
Eye Movement Desensitization and Reprocessing (EMDR): Often used for trauma, EMDR can also be effective in addressing deeply embedded negative beliefs and emotional patterns that contribute to depression.
Ketamine-Assisted Psychotherapy (KAP): KAP combines the use of ketamine with structured psychotherapy to help people access emotional material that can be hard to reach in ordinary states of consciousness. Delivered in collaboration with a licensed prescriber, KAP may be particularly helpful for those who haven’t responded to more conventional treatment approaches. The therapy component is central—helping clients integrate insights and emotional shifts that arise during ketamine sessions.
A Different Kind of Support
Living with depression that doesn’t lift easily can be deeply isolating—but there is help. The goal of therapy isn’t just to “fix” you—it’s to help you understand yourself, build a relationship with the parts of you that are struggling, and reconnect with a sense of vitality.
You don’t have to carry the weight of figuring this all out by yourself. A skilled therapist can help you understand what’s happening beneath the surface and guide you through depression therapy that actually work for you.
If you’re navigating treatment-resistant depression and want support that honors your experience, I invite you to reach out. You don’t have to keep figuring it out alone.