Treatment-Resistant Depression: The High Cost and How to Save - WebMD

About 30% of people with depression don't get any help from at least the first two medications they try. That's what doctors call treatment-resistant depression.

This condition can be very expensive. Research suggests that people with treatment-resistant depression spend close to $1,300 a year on out-of-pocket medical and drug costs. They may spend up to 134% more on health care costs than people with depression that responds to treatment.

Here's a look at why that is and what you can do to improve the situation -- both for your mental health and your budget.

The Cost of Treatment-Resistant Depression

Treatment-resistant depression can come with a lot of costs -- not just additional medical costs, but other, indirect costs, too. They may include:

Hospitalizations and ER visits. When you have treatment-resistant depression, you are almost 40% more likely to end up in the ER than someone with well-managed depression. You are 73% more likely to need a hospital stay. You may see a doctor more than three times as much. All of these medical costs add up even when you have health insurance.

Drug costs. People with treatment-resistant depression are more likely to be on several different medications, especially if you have other health problems such as osteoarthritis, joint pain, back pain, or headache. One study found that about 70% of people with treatment-resistant depression take at least five different medications.

Therapy. You may need to go to therapy in order to help manage the symptoms of treatment-resistant depression. This can be very expensive. Sessions can range from $65 to $250, depending on where you live. While the Affordable Care Act requires all insurance plans to cover mental health care, you will still need to meet your annual deductible and pay a copayment, which may be $50 or more. But for many people, a copay isn't enough to cover the session. Some research suggests that fewer than half of psychiatrists take Medicare or private insurance. In that case, you may pay much more.

Lost income. People with treatment-resistant depression report about $1,800 in lost income each year. On average, they miss almost 36 days of work a year. That's 1.7 more days than people with well-managed depression and 6.2 more days than people who don't have any sort of depression. People with this condition also tend to be less productive at work and may find it harder to hold down a job. Some research has found that almost half of all people with severe treatment-resistant depression eventually end up unemployed.

How to Manage Depression-Related Expenses

Depression is expensive for everyone. Oftentimes, the costs of cognitive behavioral therapy and prescription drugs deter people with depression from getting the help they need. If you have treatment-resistant depression, here are some things you can do to make it more affordable: 

Search out low-cost therapy. Therapy is very effective, but it's expensive. You may be able to find cheaper therapy if you do the following:

• Ask the therapist or clinic if they offer therapy on a sliding scale. This means that their hourly rate depends on your income. 
• Try a federally qualified health center (FQHC). Many offer mental health services and allow you to pay what you can afford based on your income. You can find centers in your area at findahealthcenter.hrsa.gov.
• Call your local university psychology and psychiatry departments. Both may offer supervised sessions with graduate students at a lower cost.

Check out patient assistance programs. Many antidepressants are available as generics at a low price. But if your depression hasn't responded to them and your doctor wants you to try a more expensive drug, many pharmaceutical companies offer patient assistance programs, which provide medication at little to no cost. Your doctor can help you contact the drug company directly to ask. NeedyMeds, a national nonprofit, also offers drug discount cards that help you save up to 80% off the price of prescription medications. 

Ask about clinical trials. Before a treatment is approved by the U.S. Food and Drug Administration, it's tested on volunteers for free in a clinical trial. This is a good way to get access to free medication and certain treatments that may not be available to the public yet. You can search for a clinical trial on the Anxiety and Depression Association of America's website.

Download a mental health app. Many are free and can help you manage your symptoms. They should not replace treatments like therapy and medication, but they can enhance your care. You can search for apps on the M-Health Index and Navigation Database (MIND), which was developed by a team at Harvard Medical School.

Focus on lifestyle. A healthy diet and daily exercise won't cure treatment-resistant depression, but they can make it more manageable. Even better, these strategies won't cost you a lot of money. Here are some lifestyle choices that may help:

• Have fish for dinner. A Mediterranean-style diet, an eating pattern rich in fruits, veggies, whole grains, beans, seafood, and healthy fats like olive oil, has been shown to help reduce the risk of depression. 
• Try meditation or yoga. Stress can worsen depression, including treatment-resistant depression. Techniques to calm your mind such as yoga, tai chi, meditation, or even journaling can help. A 2021 study published in the British Journal of Sports Medicine, for example, found that regular yoga practice improves symptoms of depression.
• Sleep better. Insomnia doubles depression risk. Poor sleep may worsen depression because it affects your energy level and your ability to handle stress. Simple fixes like keeping a regular bedtime and wake-up time and limiting screens before bed can help.
• Walk every day. It's a simple, low-cost form of exercise. In a 2022 review in JAMA Psychiatry that looked at 15 studies of over 190,000 people, those who walked briskly for 2.5 hours a week had a 25 percent lower risk of depression.

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