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Depression, Treatment-Resistant Depression, and Postpartum Depression


Depression is a complex mental health condition, characterized by feelings of sadness, fatigue, difficulty concentrating, and general apathy. Depression often causes disruptions in sleeping and eating patterns, interpersonal relationships, personal productivity, and our own self-esteem. What we know about depression is constantly evolving. Researchers still don’t know the exact cause of depression, but it is likely that multiple factors are involved.

What Causes Depression?

Depression is often thought of as a chemical imbalance in the brain, but that only partially describes the condition. In fact, multiple issues are thought to contribute to depression, including inability to properly regulate mood, genetic predisposition, and external factors such as stress, trauma, or grief.

woman-feeling-depressedWhile brain chemicals (such as serotonin and dopamine) are involved, it is not quite as simple as being a certain percentage too low for a specific chemical. Rather, multiple factors contribute to depression, and an imbalance of brain chemicals may be a symptom of another cause, rather than the direct cause of depression.

There are several million chemical reactions that are involved in determining your mood, your outlook on life, and how you respond to external stimuli. This level of complexity makes depression a complex disease to treat. Two people may have similar symptoms of depression but respond entirely different to the same treatments. Source

It is important when dealing with depression to communicate openly with your mental health provider, follow all prescribed treatment, and not to get frustrated if one treatment option fails to deliver the anticipated relief.

Symptoms of depression

  • Feeling very sad, hopeless or worried
  • Not enjoying things that used to bring joy, such as hobbies or social activities
  • Being easily irritated or frustrated
  • Overeating or eating too little, which can cause rapid weight gain or weight loss
  • Difficulty sleeping (insomnia) or sleeping too much (hypersomnia)
  • Having low energy or fatigue, constantly feeling exhausted
  • Having a difficult time concentrating or remembering things
  • Experiencing physical issues like headache, stomachache or sexual dysfunction
  • Having thoughts of self-harm or suicide


Severity of depression

The severity of depression covers a wide range of expression, from relatively mild feelings of “feeling down” or “feeling blue” up to serious thoughts of self-harm or suicidal ideation. The sooner depression is diagnosed and treated, the better the chance of preventing it from progressing to more severe forms of depression. If you suspect that you, a friend, family member, or partner is experiencing depression, the best step you can take is to schedule an appointment with a psychiatrist or psychiatric mental health nurse practitioner as soon as possible to receive an accurate diagnosis and treatment plan.

Types of depression


Depression is a catch-all term that may refer to several different types of depression. When used in everyday speech, a person who says they are depressed is likely referring to major depressive disorder. But there are other forms of depression, each with its own characteristics, expected duration, and preferred treatment options.

Major Depressive Disorder

Major Depressive Disorder (often abbreviated as MDD) is a clinical diagnosis of depression. Major depressive disorder is diagnosed after someone has felt sad, low or worthless most days for at least two weeks, while also experiencing accompanying symptoms such as sleep problems, loss of interest in activities, or change in appetite. Major depressive disorder is the most severe form of depression and is also the most common form of depression. Patients who visit Ampelis Health in Utah for depression treatment are often dealing with Major Depressive Disorder.

solitary-depression-aloneSAD and Postpartum Depression – Types of Major Depressive Disorder

SAD and postpartum depression are two distinct types of major depressive disorder that are triggered by known events.

Seasonal affective disorder (SAD) is a form of major depressive disorder associated with the change of seasons. It typically has an onset during the fall or winter and goes into remission during the spring and summer.

Pregnancy is associated with two types of depression: postpartum and prenatal depression. Prenatal depression describes depression that occurs during pregnancy, while postpartum depression refers to depression that develops within four weeks of delivering a baby. Read more about Postpartum Depression

Treatment-resistant Depression

Treatment-resistant depression is a form of major depressive disorder that is not adequately resolved after at least two different medication attempts. Treatment-resistant depression has gained attention in recent years because of two important events: the release of the STAR*D trial data and the wide adoption of treatments proven to help treatment-resistant depression.

STAR*D Trial

The STAR*D trial is the largest and longest study to evaluate the use of antidepressants for depression treatment. The trial ended in 2006 and the trial findings were released in 2008. The STAR*D trial closely mimicked the typical care pathway of a patient with depression. The trial consisted of four levels. At each level, a patient was prescribed an antidepressant. If the patient’s depression was resolved, the patient did not advance further in the trial. If the patient did not achieve adequate relief (defined as a 50 percent reduction in severity of symptoms), the patient moved to the next level of the trial and tried a different antidepressant medication.

The trial methodology was very similar to how doctors prescribe antidepressants to patients in clinical practice. If the current prescription works, the patient stays with that prescription. If it doesn’t work, another prescription is attempted, and so on.

The STAR*D trial was the first trial to conclusively show that a significant percentage of patients have treatment-resistant depression (did not achieve at least a 50 percent reduction in severity of symptoms after at least two different medication attempts). In the STAR*D trial, about 42 percent of total patients advanced to the third stage, meaning they could be considered to have treatment-resistant depression.

Other studies corroborate the STAR*D trial findings, with the typical range of patients identified as having treatment-resistant depression ranging from about 33 percent to 40 percent of all patients. So if you have been diagnosed with treatment-resistant depression, or you have tried multiple antidepressants without success, know that you are not alone and there is hope with new treatments available.

New Treatments for Treatment-Resistant Depression

While “treatments for treatment-resistant depression” sounds like an oxymoron, it’s important to remember that “treatment-resistant depression” refers to depression that is resistant to treatment with antidepressants. Non-antidepressant treatments, such as ketamine and TMS, are now readily available and have been proven to work for even the most resistant cases of depression.


Treatments for depression


Therapy is a common treatment for depression and often one of the first places patients turn to for relief. Discussing your condition and specific triggers with a qualified mental health professional can help you regain control of your thought patterns, identify healthy coping strategies, and prepare a plan to prevent or redirect future depressive episodes.


There are a wide variety of antidepressant medications available today. A psychiatrist or psychiatric mental health nurse practitioner at Ampelis Health can help you identify the right medication for your needs. Our providers can prescribe new medications, issue medication refills, or change medication dosages as needed.

Ketamine Assisted Psychotherapy

Ketamine-assisted psychotherapy treats depression with a combination of talk therapy (psychotherapy) and ketamine therapy. During ketamine-assisted psychotherapy, the patient is administered ketamine and then undergoes a therapy session with a therapist while experiencing the therapeutic effects of ketamine. This combination of treatments has been shown to be productive in helping a patient move past blocking issues such as trauma, depression, or PTSD and make rapid progress in healing.

Transcranial Magnetic Stimulation (TMS)

TMS is a safe, effective treatment delivered in a psychiatrist’s office to treat mental disorders like depression. TMS works by producing a stimulus/response effect in the brain. Over the course of a series of treatments, the brain begins to develop new, healthy pathways that produce healthy brain function once again.

TMS has gained popularity in recent years as a preferred treatment for depression because it is FDA-approved and covered by many insurance companies for depression treatment. TMS is especially appealing for many patients because it does not require taking medication and it can assist many patients to reduce or eliminate the need for antidepressants.


Which treatment is best for depression?

The best depression treatment is individual for each patient and depends on your personal circumstances, taking into consideration the type of depression, length of time you’ve had depression, the severity of symptoms, time available for treatment, and your insurance coverage, among other considerations.

At our two Utah Ampelis Health locations, we treat depression with custom care plans specific to you and your needs, with full consideration for your unique situation.

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