Many people with depression do not respond to treatment at first, but it is essential that these patients do not give up hope and are encouraged to try different treatments, doctors have insisted.

Mental health problems are very common and 25% of people will be affected by depression at some stage in their lives.

According to consultant psychiatrist, Dr Declan Lyons, and psychiatry registrar, Dr Clare Shields, both of St Patrick's Hospital in Dublin, depression is the fourth highest cause of disability worldwide and is an ‘extremely common presentation' to GPs.

Yet a ‘significant number ‘ of those affected do not respond to their initial treatment. While there is no exact definition for treatment-resistant depression, it is generally considered to be a failure to respond satisfactorily to two different trials of antidepressant treatment.

The doctors believe that before diagnosing a patient with treatment-resistant depression, it must first be established that depression is the actual problem, as other mental health conditions, such as anxiety disorders or alcohol abuse, can have similar symptoms.

It is also important to rule out any other health conditions, such as dementia or Parkinson's disease.

Patients must be prescribed ‘an adequate trial of an antidepressant' - usually six to 12 weeks, although a response is generally expected after four weeks. It is also important to make sure the patient is taking their medication correctly.

If a patient is found to be non-responsive to their medication, options include changing the class of drug or adding a second drug to the first.

Meanwhile, the doctors also emphasised that psychotherapy can be used ‘as an alternative to medication in mild to moderate depression and can be useful in severe depression in combination with medications'.

They noted that psychotherapy, such as cognitive behavioural therapy, can be particularly helpful in the prevention of a relapse, however they added that the ‘availability of psychotherapy is frequently a limiting factor'.

The doctors also pointed out that social support has a big role to play. The support of family and friends and organisations such as Aware can make a major difference to those affected.

If none of these steps work, referral to a psychiatrist should be considered.

"This is recommended for patients who do not respond to between two and four treatment trials. Referral is also required if psychosis, suicidal ideation or catatonia are present," Dr Lyons and Dr Shields said.

They insisted that people with treatment-resistant depression must be ‘regularly reviewed'.

"We need to emphasise the importance of persisting with treatment trials and these patients require reassurance that they will not be abandoned and they should be encouraged to have faith in the treatment," the doctors commented.

They added that people working in this field ‘need to draw on all the resources available to them' and keep themselves up to date on the latest treatment developments.

Dr Lyons and Dr Shields wrote about this topic in WIN (World of Irish Nursing & Midwifery), the Journal of the Irish Nurses and Midwives Organisation.

For more information on depression, see our Depression Clinic here