“If medication isn’t helping me, maybe it’s just me” : narratives of treatment resistant depression : a thesis presented in partial fulfilment of the requirements of the degree of Doctor of Clinical Psychology at Massey University, Albany, New Zealand

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Massey University
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A significant proportion of people with depression do not experience expected improvement following treatment and are considered to have treatment resistant depression. Despite this, there is relatively little research exploring the experiences of this group, who represent a significant minority of those who experience depression. The current study explored how people with treatment resistant depression make sense of depression that has not resolved following adherence to professional advice and treatment. The accounts of nine people with treatment resistant depression recruited from a private psychiatry practice in Auckland, New Zealand were analysed using narrative analysis. The participants told stories about what it was like to experience depression that persisted over many years using two narratives: that of order and of disorder. The narrative of order was used to organise and make predictable their experiences. The narrative of disorder was used to describe the ways their depression defied predictability and management. The participants also told stories to account for why they had remained depressed long-term despite receiving treatment. At times, participants attributed their persistent distress to having a treatment resistant brain or personality. There were also two alternative accountings - a narrative of bad patient behaviour and a narrative of it just taking some time to find a suitable medication. These accounts were strongly shaped by narratives of mental distress and recovery that suggest that depression follows predictable patterns and that treatment results in resolution of symptoms. Today, these narratives are increasingly encompassed by powerful and pervasive narratives of neoliberalism. The participants in this research emphasised personal accountability and self-management, and self-blame when they did not achieve the desired and expected outcome of resolution of symptoms. The implications of these findings for those experiencing persistent distress, such as TRD, as well as for health professionals working in mental health domains are discussed.
Depressed persons, New Zealand, Attitudes, Depression, Mental, Treatment, 520302 Clinical psychology