Do I Have Treatment Resistant Depression? (best therapy options, major depressive disorder treatments, and how to move forward)
- Jeromy Deleff, MACP, CT, CCC, CCTP-II
- Sep 21
- 9 min read
Do I Have Treatment Resistant Depression? Feel stuck after trying help? Learn signs, evidence-based therapy options, and next steps in Calgary. Book a free 20 minute consultation with our depression clinician today.
Key Takeaways
Treatment resistant depression (TRD) doesn’t mean you’ve failed; it often means the first steps didn’t fit your brain, body, history, or life stage. Evidence-based treatment options still exist—including psychological therapies that can be proven effective for Major Depressive Disorder.
A practical way to wonder “Do I have TRD?” is to review whether you’ve had adequate trials of care and still have depression symptoms affecting your quality of life. Simple depression tests (like the PHQ-9) can help track symptom severity over time, but diagnosis comes from mental health professionals.
Psychotherapies like Cognitive Therapy for depression (CBT), behavioural activation, Mindfulness-based approaches (MBCT), and Interpersonal depression therapy (IPT) are science-based forms of therapy that can be goal-oriented, build life skills, and restore a sense of control—especially when earlier steps haven’t helped enough.
If you’re in or near Calgary, it can help to meet with a trained therapist who understands severe depression, seasonal affective disorder, chronic stress, relationship challenges, and life transitions—and who offers non-judgmental support and a strong therapeutic alliance.
Estimated read time: ~9 minutes Gentle disclaimer: This article is educational and supportive, not medical advice. If you’re in crisis or thinking of suicide, call or text 9-8-8 in Canada, or dial 911.
Quick Resources (Near the Top, Because You Asked for Strategic Internal Links)
Looking for a primer on our approach? See our service page: Depression Therapy in Calgary.
Curious about specific modalities? You might like:
First Things First: What Do Professionals Mean by “Treatment Resistant Depression”?
You’ll often see treatment resistant depression used when there’s a lack of response to initial treatments—for example, when you’ve tried at least one or two evidence-based steps (like an antidepressant or a course of therapy for depression) at an adequate dose and duration, and depressive episodes keep returning or core symptoms remain. Newer guidelines also talk about “difficult-to-treat depression” (DTD), which recognizes that real-life barriers—like chronic pain, sleep problems, or trauma history—can make depression harder to shift even when you’re doing many things “right.”
TRD is not a personal failing. It’s a signal to reassess and personalize your approach to treatment—considering your history, supports, current life stages, medical conditions, and what actually matters to you day-to-day. Leading guidelines (CANMAT in Canada; NICE in the UK) recommend a stepwise, collaborative plan and using validated measures to track progress.
Signs You May Be Dealing With TRD (And When It’s “Just” a Tough Episode)
If you’re unsure whether your current struggle is another depressive episode or something that needs a different plan, here are patterns people often report:
Persistent core symptoms—like depressed mood, loss of interest, fatigue, sleep changes, or poor concentration—despite following through on treatment.
You complete a reasonable trial of medication or therapy, yet the signs of depression (for example, feelings of helplessness, irritability, or slowed-down energy) keep you from work, relationships, and the meaningful life you want.
You improve a bit, but residual symptoms linger (e.g., low motivation, insomnia), and they repeatedly pull you back into poor moods.
Factors like family history, history of depression, chronic stress, seasonal affective disorder patterns, or comorbid health conditions (e.g., chronic pain) seem to keep the embers glowing.
If that sounds familiar, a helpful next step is to measure where you are. Many clinicians use the PHQ-9—a brief, research-backed questionnaire—as a depression test to track severity and change over time. It doesn’t diagnose by itself, but it’s widely used and research-based.
Important: If you’re having thoughts of suicide, please treat that as urgent and reach out right now. In Canada, call or text 9-8-8 or visit the Public Health Agency’s “Get help” page for supports. You’re not alone.
Why Depression Can Be Hard to Treat
Depression is a mood disorder with biological, psychological, and social threads. Older shorthand like “chemical imbalance” captures a piece of the story, but modern science sees depression as a complex system: genetics and life stages, stress hormones, sleep/circadian rhythm, learning histories, unhelpful thinking patterns, and current environment all interact. That’s why an experienced Counsellor will step back and map aspects of depression in your life rather than pushing a single tool.
Common “hidden anchors” include chronic stress, grief, isolation, relationship challenges, alcohol or substance use, medical issues (thyroid, iron, pain), and life transitions. Addressing these doesn’t magically cure clinical depression, but it can make symptoms more alleviated—as part of a comprehensive treatment for depression guided by a trained therapist and other health providers.
What Actually Helps When First Steps Haven’t?
1) Cognitive-Behavioural Therapy (CBT): Retrain Patterns That Keep You Stuck
CBT, developed by Aaron T. Beck and advanced by colleagues like Judith Beck and Steven Hollon, targets unhelpful thinking patterns (“I’ll never get better”) and ramps up behavioural activation—structured, goal-oriented steps that reconnect you to meaning, mastery, and life skills. Large meta-analyses support CBT as an effective treatment for depression across severities. Behavioural activation in particular is simple, practical, and can rival full CBT for outcomes.
2) Mindfulness-Based Cognitive Therapy (MBCT): Train Attention, Reduce Relapse
Pioneered by Zindel Segal, Mark Williams, and John Teasdale, MBCT blends mindfulness training with CBT skills. For many with recurrent Major Depressive Disorder, MBCT can reduce relapse risk compared with usual care and performs on par with maintenance antidepressants for some individuals—especially when you prefer a psychological route.
3) Interpersonal Therapy (IPT): Strengthen Bonds, Ease Mood
IPT focuses on healthy relationships, grief, role transitions, and conflict—key levers for mood. When relationship challenges or life transitions (new parenthood, separation, retirement) fuel poor moods, IPT is a research-based form of treatment aligned with what many of us truly need: better connection.
4) Dialectical Behavior Therapy (DBT) Skills: Ride Waves, Choose Wise Action
DBT (from Marsha Linehan) adds stress management, emotion regulation, and mindfulness-based approaches to help you tolerate mental pain and act on values even when energy is low. For some with severe depression or patterns of emotional intensity, DBT skills can be the “grip” that allows other therapies to finally take hold.
5) Lifestyle Medicine as Therapy-Adjacent Care
Guidelines encourage movement, sleep hygiene, and routine—behavioural activation in everyday clothing. Even small, goal-oriented changes can rebuild a sense of control and gradually overcome depression. (As always, go gently; tough times call for pacing, not perfection.)
You might be searching for the best therapy for depression. The honest answer: it’s the one that fits your pattern, values, and supports a strong therapeutic alliance—that reliable, non-judgmental therapeutic space where you and an effective therapist tackle barriers together.
Where Do Medications Fit if You’re Therapy-Leaning?
Medication can be essential or optional—it depends. If you’ve had Major Depressive Disorder with repeated episodes, a clinician may talk about antidepressants—and you might even see the term spelled online as “antidepressents.” What matters is whether your treatment has been adequate (dose, duration, adherence) and whether augmenting, switching, or combining with psychotherapy is indicated. Contemporary guidelines urge shared decision-making with your prescriber and therapist; psychological care remains core whether you use medication or not.
A Practical Self-Check: “Do I Have TRD—and What Now?”
Ask yourself:
Have I tried at least one or two evidence-based steps adequately? For therapy: typically 8–16+ sessions of a science-based form of therapy (CBT, Interpersonal depression therapy, MBCT), with homework/skills practice.For meds: a full, guideline-level trial with follow-up.If not, your depression may not be “treatment resistant”—you may simply need the right fit or more time.
Are key symptoms still active? Track Major depressive disorder symptoms (sleep, depressed mood, concentration, energy). The PHQ-9 can give a clear before/after snapshot to guide counselling sessions, not replace assessment.
What keeps the embers hot? Consider chronic stress, seasonal affective disorder, chronic pain, substance use, loneliness, or unresolved losses. These are part of your personal journey, not detours.
Do I have the support I need? Many people benefit from Individual Counselling with an experienced Counsellor, plus care from a family doctor or psychiatrist. Organizations like the Canadian Mental Health Association. share education and community resources. (Diagnosis and medication discussions belong with medical providers.)
If you resonate with TRD, it’s time for a comprehensive treatment for depression—a stepped plan that’s goal-oriented and matched to your story. Guidelines emphasize collaborative, research-based care (psychotherapy, condition-specific skills, and, when needed, medication changes).
What This Looks Like With a Calgary Depression Therapist
At Compassionate Central in Calgary, we focus on direct counselling approaches that are warm and strength-based:
CBT and behavioural activation to rebuild structure, energy, and meaning.
Mindfulness-based approaches to unhook from ruminative loops and widen attention.
Interpersonal work to repair or grow healthy relationships.
Skills for stress management, values-based action, and life skills that restore momentum.
Together we’ll define a few goal-oriented targets (better mornings, fewer shutdown days) and measure what’s changing. The aim is successfully managing depression—not perfection—so that your days feel more workable and your quality of life grows. This is mental health care that respects your personal development.
Why Evidence Matters (And How We Use It)
CANMAT (2023 update) and NICE (2022) both recommend stepped, personalized care for Major Depressive Disorder and outline pathways when earlier steps don’t help—combining psychotherapy and, when appropriate, medication strategies.
NIMH and the Government of Canada outline Major depressive disorder treatments and depression symptoms, reminding us that improvement is often gradual—and that help is available.
Research on MBCT and behavioural activation shows these therapeutic modalities can be proven effective for many, including folks who’ve struggled with clinical depression for years.
Contemporary reviews clarify that TRD is best understood as insufficient response to appropriate care—not as a personal flaw—encouraging collaborative persistence.
Frequently Asked Questions
1) How Many Treatments Have to “Fail” Before It’s Called Treatment Resistant Depression?
There’s no single global rule, but many clinicians use non-response to at least one or two adequate trials (medication and/or structured psychotherapy) to consider TRD and shift the plan. The point is to personalize care when first steps aren’t enough.
2) Can Therapy Help if Medications Haven’t?
Often, yes. Therapies like CBT, behavioural activation, MBCT, and IPT target habits, attention, and relationships—mechanisms that medications don’t always reach—and are well-supported by evidence.
3) Is There a “Best Therapy for Depression”?
The “best” is the one that fits your pattern and enables a solid therapeutic alliance. CBT/BA, MBCT, and IPT are all research-based forms of treatment; your effective therapist will help you choose and adapt them.
4) What About Online Self-Tests?
Tools like the PHQ-9 can help you and your clinician monitor symptoms and response to care. They don’t replace a full assessment by mental health professionals.
5) I Think Seasonal Affective Disorder Plays a Role. Should I Treat That First?
Treat both the episode and the seasonality. Behavioural routines, morning light, sleep regularity, and stress management can support psychotherapy focused on winter-linked patterns. (Discuss options with your care team.)
6) How Long Until I Feel Better?
Timelines vary. Many see early shifts within a few weeks of focused work; others need more time. We track your progress, adjust treatment options thoughtfully, and celebrate small wins that build resilience.
Ready to Take a Next Step?
If you’re in or near Calgary and you’d like a non-judgmental place to talk through depression problems—including TRD concerns—we offer depression counselling services for adult depression grounded in evidence and compassion. Book a free 20-minute phone consultation to see if we’re a fit: Start your consult here.
Clinic Information (For Local Readers)
Compassionate Central: Counselling & Therapy
Address: 5940 Macleod Trail SW, Suite #500, Calgary, AB T2H 2G4
Phone: (587) 328-7732
Services: Cognitive behavioral therapy for adults; depression and anxiety counselling; in-person and secure virtual sessions. Sliding-scale spots released periodically.
Accessibility: Elevator access; on-site parking; transit-friendly.
References (Selected)
Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update. Canadian Journal of Psychiatry (2024). Evidence-informed recommendations across psychotherapy, pharmacotherapy, and neuromodulation; emphasizes personalized, stepped care and defines TRD/DTD.
NICE Guideline NG222 (2022): Depression in adults—treatment and management. Stepped care; first-line and further-line psychological and medication options; relapse prevention guidance.
NIMH: Depression. U.S. National Institutes of Health—signs, types, and treatments overview.
Government of Canada—Depression (PHAC). Signs and symptoms; public-health supports; crisis resources including 9-8-8.
PHQ-9 validation. Kroenke, Spitzer, Williams (2001), J Gen Intern Med. Widely used measure for depression severity and monitoring.
MBCT relapse prevention. Kuyken et al. (2015), The Lancet randomized trial comparing MBCT vs maintenance antidepressants.
Behavioural activation effectiveness. Cochrane Review summary (2020): BA comparable to CBT; beneficial vs usual care/humanistic therapy.
Contemporary perspective on TRD. McIntyre et al. (2023): definition and management overview.
Author
