What it is, and how it is treated

What treatment-resistant means

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In practice it means this: you have taken two or more antidepressants at a proper dose for a proper length of time, you have probably done a course of CBT, and you are still depressed. Perhaps you have been told you have a chemical imbalance and simply need the right combination. Perhaps you have started to believe that this is just who you are.

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In my experience of general practice and psychotherapy, depression that does not respond to these treatments is rarely a random biological event. It is usually depression with a history: early loss or neglect, trauma, a relationship or a role in which your own feelings were never permitted, or a chronic illness or pain that has worn the self down. Antidepressants and CBT work on the symptoms. They do not reach what is maintaining them.

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How I treat it

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I offer two things, depending on what fits.

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Psychodynamic Interpersonal Therapy (PIT) is a brief, defined treatment of 8 to 16 sessions developed for exactly this group. In randomised trials it has been shown to help with depression that has not responded to other treatment, with physical symptoms that have no medical explanation, and with self-harm.

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Longer-term psychotherapy using the Conversational Model is for depression that sits on top of complex trauma or long-standing difficulties with self and relationship. This is weekly, open-ended work.

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Neither uses worksheets or homework. Both are conversations in which attention is paid to feeling as it arises, to the particular texture of your experience, and to what happens between us, because that is usually where the pattern shows itself most clearly.

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Medication

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I am a medical practitioner, so I understand the medication you are on and can discuss it with your GP or psychiatrist. Prescribing generally stays with your own doctor, and I write to them. Many people are able to reduce medication over the course of therapy, but that is a decision made slowly and with your prescriber, never on your own.

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Who it suits

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Adults and older adolescents with depression that has lasted more than a year or returned repeatedly despite treatment; depression alongside chronic pain, fatigue or unexplained physical symptoms; depression with a history of trauma or loss; and people who have been told they have treatment-resistant depression and want something other than a fourth medication.

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Medicare and referral

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Because I am a GP, a Medicare rebate applies to every session with a referral letter from your GP or psychiatrist addressed to me by name. There is no Mental Health Care Plan and no ten-session cap, so a full course of PIT or longer-term therapy is covered. Sessions are in person in Byron Bay or by video. Telehealth rebates generally need an in-person visit in the previous 12 months.

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For referrers: I welcome referrals of patients with treatment-resistant depression, medically unexplained symptoms and depression with chronic illness from GPs and psychiatrists across the Northern Rivers, Tweed and Gold Coast. Call the practice on 0455 494 858 and I will call you back.