If you’ve been living with depression for a while, you already know the drill. You try the meds. You go to therapy. You meditate, journal, take your vitamins, maybe even get some sunshine like the internet told you to… and still feel like you’re running on emotional fumes.

If that sounds familiar, you might be dealing with treatment resistant depression — or, and this is a big one — maybe you’ve just never had the right kind of treatment.

What Is Treatment Resistant Depression?

Treatment resistant depression (TRD) is what happens when depression doesn’t respond to the usual stuff — like antidepressants or talk therapy — even after giving it an honest shot.

But before you start googling “am I broken,” please know this: “resistant” doesn’t mean hopeless. It doesn’t mean you’re not trying hard enough or doing something wrong. It usually means your brain and body need a different kind of help — something that works from the bottom up instead of just the top down.

Because let’s be real — you can’t out-think a nervous system that’s still in survival mode.

Why Does Treatment Resistant Depression Happen?

Depression is complicated. There’s no single cause, and there’s definitely no one-size-fits-all cure. Sometimes it’s about brain chemistry or genetics. Sometimes it’s about trauma, chronic stress, or even just trying to function in a world that’s been asking too much of you for too long.

And sometimes, it’s not that you’re resistant — it’s that the treatment hasn’t been aligned with how your system actually works.

Maybe therapy focused on managing thoughts when your body was the one holding the pain. Maybe meds numbed the symptoms but didn’t touch the root. Maybe you just haven’t had a therapist who really gets what it means to live in a constantly overclocked nervous system.

None of that means you’ve failed treatment. It means treatment failed to meet you where you are.

Who’s More Likely to Experience It?

Anyone can experience treatment resistant depression, but certain patterns show up again and again.

If your depression started young or you grew up in chaos, you might have more complex wiring that keeps you stuck in emotional survival mode. If you live with chronic pain, autoimmune stuff, or ADHD, your brain’s already juggling enough.

And honestly? The folks who are smart, sensitive, and self-aware — the overthinkers, the fixers, the people who “hold it all together” — are often the ones quietly falling apart inside.

This isn’t a character flaw. It’s a nervous system doing its best to keep you alive, even if that means keeping you stuck.

When Talk Therapy Isn’t Enough: Bottom-Up Approaches

If you’ve been in therapy for years but still feel like nothing’s changing, that might not be because therapy doesn’t work — it might be because you’ve only tried top-down therapy.

Bottom up therapy (like EMDR and somatic approaches) works differently. Instead of just talking about what happened, you’re helping your body and brain reprocess it so you can finally stop living like it’s still happening.

At Empower Counseling, we specialize in these approaches:

• EMDR Therapy: Helps your brain file away stuck memories so they stop hijacking your mood.
• Somatic and Attachment-Focused EMDR (SAFE): Adds body awareness and relationship repair for deeper, long-term change.
• Mindfulness-Based Cognitive Therapy: Blends mindfulness with CBT to quiet self-criticism and reduce relapse.
• Relational Therapy: Because healing happens through connection, not performance.

When you work with your nervous system instead of trying to reason with it, the shift is real.

When Medical Options Help Too

Sometimes even with the best therapy and meds, depression digs in its heels. That’s when other medical treatments — like TMS (Transcranial Magnetic Stimulation) or ketamine-assisted therapy — can help reboot the system.

We don’t offer those at Empower Counseling, but we collaborate closely with prescribers who do. If it makes sense for your care, we’ll help you find a provider and integrate that support safely and effectively.

The Bottom Line

If you’ve been asking yourself, “Is this treatment resistant depression or am I just beyond help?” — please hear this: you are not beyond help. You might just need a different kind of help.

You’ve probably tried to think your way out of it, motivate your way out of it, or gratitude-journal your way out of it. You really have given it everything — no wonder you’re exhausted… but healing depression often means going deeper… into your nervous system, your relationships, and your story.

At Empower Counseling, we combine evidence-based trauma therapy with a whole-person, nervous-system-first approach. We see the full picture — the burnout, the perfectionism, the self-blame — and help you find your way through it with compassion and clarity.

If you’re ready to explore what’s possible beyond the usual treatment path, we can help. Let’s talk about what’s been keeping you stuck… and what your brain’s been trying to protect you from all along.

Additional related topics

• Feeling Stuck in Life? These 11 Signs Could Point to C-PTSD
• Why Do I Sabotage Myself? (And how to stop burning down your progress)
• 4 Subtle Signs of Trauma and Complex Trauma: Are You Dealing with More Than You Think?
• What is Trauma? Do I Have It? How Can Trauma Therapy Help?
• Trauma Therapy: Why it’s More Than Just Talk