Depression Therapy

“Out of suffering have emerged the strongest souls; the most massive characters are seared with scars.”

—Gibran Khalil Gibran

Are You Struggling with Depression? You Are Not Alone.

While it’s normal to feel sad or "down" from time to time, these emotions are usually temporary and tied to specific events or situations. However, when these feelings become persistent and pervasive, interfering with daily functioning, they may evolve into a clinical condition known as Major Depressive Disorder (MDD). 

MDD can feel like your emotions, thoughts, and even your body are out of sync. It’s not just feeling sad—it can make everyday tasks, relationships, and even just getting through the day really hard. You might find yourself struggling at work, with family, or even with just getting out of bed, because the weight of everything feels too much to carry.In such cases, clinical or medical intervention is often necessary to address the condition beyond the typical fluctuations in mood or external circumstances.

You may be experiencing depression or MDD if you’ve had five or more of the following symptoms for at least two weeks, with at least one being a depressed mood or loss of interest in things you once enjoyed:

  • Persistent sadness or a "down" mood

  • Loss of interest in activities that used to bring pleasure

  • Changes in appetite or significant weight fluctuations

  • Sleep disturbances (difficulty sleeping or sleeping too much)

  • Fatigue or a constant lack of energy

  • Feelings of guilt or worthlessness

  • Difficulty concentrating or making decisions

  • Thoughts of death or suicide

Depression can also manifest in irritability, physical aches and pains, or social withdrawal, which can sometimes be overlooked signs of the condition.

For many individuals, depression can be a chronic condition, lasting months or even years, despite its treatment with medication and conventional therapy. Such severity is often referred to as Treatment Resistant Depression (TRD) or Difficult to Treat Depression (DTD). 

So, What is Treatment Resistant Depression or Difficult to Treat Depression?

About 40% of individuals diagnosed with Major Depressive Disorder (MDD) experience Treatment-Resistant Depression (TRD), which occurs when they don't respond to antidepressant medications. Over time, the definition of TRD has been expanded to include cases where symptoms relapse after a period of remission induced by medication. However, it’s important to note that TRD specifically refers to a lack of response to pharmacological treatments and does not include non-responsiveness to non-pharmacological options, such as psychotherapy or other psychosocial interventions.

In recent years, there has been a significant transition from the model of TRD to Difficult to Treat Depression (DTD), which favors a much broader and more inclusive approach to treating depression.

DTD focuses on the importance of considering mental state, relationships, and life circumstances, including trauma and adverse childhood experiences, that influence the response to the treatment of depression. 

Key indicators of DTD:

  • Lack of response to multiple treatments:
    Not seeing significant improvement after trying two or more different antidepressants at adequate doses and durations. 

  • Severe and persistent symptoms:
    Experiencing very intense depressive symptoms that last for a long time, even with treatment. 

  • High relapse rate:
    Frequent episodes of depression returning even when medication is being taken consistently. 

  • Chronicity:
    Having a long history of depression with multiple depressive episodes. 

  • Anhedonia:

  • An inability to experience pleasure

  • Comorbidity with other conditions: 

  • Anxiety, PTSD, or substance abuse alongside depression

How Does Trauma Affect Depression and TRD/DTD?

Research over the past 30 years has consistently shown that developmental trauma, such as child abuse or neglect, is a major risk factor for developing depression. It can lead to earlier onset, more severe symptoms, and make depression harder to treat, especially when it leads to difficulties such as problem-solving and resilience. Childhood trauma can also make traditional treatments less effective, complicating recovery.

Also referred to as Adverse Childhood Experiences (ACEs),Childhood Trauma includes physical, sexual, or emotional abuse, neglect, poverty, exposure to violence, or living with caregivers who have mental health or substance abuse issues. These experiences can cause lasting psychological harm, sometimes leading to conditions like Complex PTSD, which affects emotional and social development that can persist into adulthood.

Early trauma significantly impacts depression, increasing its severity and making it harder to treat. It often co-occurs with other mental health issues, such as PTSD, dissociation, or personality disorders, complicating treatment further. Trauma can also mask depression, making it harder to diagnose. Trauma-informed, personalized treatments that address both trauma and depression together tend to be more effective for those with TRD.

Research shows that trauma-informed, personalized, and integrative treatments are often more effective for people with TRD or DTD. These approaches help reduce depressive symptoms and improve remission periods by addressing both the trauma and the depression simultaneously.

We Can HELP!

At Holding Space Therapy, our clinicians specialize in understanding and treating complex childhood and developmental trauma. We focus on assessing, identifying, and addressing the struggles that survivors face, with a deep understanding of how complex trauma interacts with other mental health conditions.

Our unique treatment model offers:

A Holistic Approach – We’ve seen time and time again how effective a therapeutic approach can be when it considers the body, mind, brain, interpersonal relationships, and inner world. All of these are crucial in helping you find your path to resilience and recovery.

Focus on Connection – We know that relationships are a cornerstone of resilience, so we prioritize creating a safe, secure therapeutic relationship. Our expertise in attachment trauma helps us recognize when our clients feel safe and when they don’t—this is a fundamental part of healing. In depression, the ability to connect can be impaired, making isolation and disconnection worse. We work at a pace that feels comfortable and respectful to your current state, beginning to rebuild connection and trust.

Integration of various treatment modalities – We integrate Somatic Therapy, EMDR, Attachment-Focused Techniques, and Parts Work into our approach to create a personalized treatment plan that meets your unique needs and optimizes your healing process.

Depression does not need to be a life sentence.

Make and Appointment Today!

Meet Our Specialists

In-Person and Teletherapy Options.

Montclair Township Office

103 Park Street
Montclair, NJ 07042
[Call or Text] (201) 500-7112

There is ample onsite partking available for clients as well as elevator access in the building.

HIPAA compliant Teletherapy options to clients in New Jersey, New York, Vermont, & Florida.