Depression is not only one of the most common of the mental illnesses, but also one of the hardest to treat properly.


The goal of treating depression is complete resolution of symptoms, not merely an improvement of symptoms.  When you have tried at least two different approaches to treat your depression and you are still not feeling “back to your old self,” the depression is labeled as Treatment Resistant.

There are many different reasons why depression may become Treatment Resistant.  Since there is so much overlap of symptoms between depression and other mental illnesses such as anxiety, attention deficit/hyperactivity disorder, and bipolar disorder, as well as with physical illnesses such as thyroid disorders, fibromyalgia, migraine, low testosterone, and irritable bowel syndrome.


A proper diagnosis by a physician trained as a specialist in both physical and mental illness is the first step to recovery.  Since there is no definitive blood test or x-ray imaging for diagnosing mental illness, a proper diagnosis is achieved through an open and honest conversation between doctor and patient, in a safe, comfortable, private, and relaxed setting.


The treatment of depression should always consist of a continuation of the open and honest conversation between you and your doctor and may include psychotherapy with or without the addition of medications.  The medications typically used for depression include Lexapro, Celexa, Zoloft, Prozac, Paxil, Effexor, and Cymbalta.  In Treatment Resistant Depression, however, these medications are often not enough to provide full relief and other medications may be added to help augment the effect of the initial medication.  When multiple medications are being adjusted to treat depression, the chance for physical side effects and potential drug-drug interactions increases exponentially.

Our Specialist

Dr. Cunningham, a board certified specialist in both internal medicine and psychiatry, is uniquely trained to recognize, monitor, and manage the complexities of an advanced medication regiment.