Undiagnosed Sleep Disorders Identified as Key Factor in Apparent Treatment-Resistant Depression
Undiagnosed sleep disorders, particularly obstructive sleep apnea (OSA), are being recognized as a significant contributing factor to what appears to be treatment-resistant depression (TRD). According to recent insights, OSA can cause chronic fatigue and low mood that standard antidepressant treatments cannot effectively overcome if the sleep disorder remains untreated. This issue falls under the category of 'pseudoresistance,' where modifiable factors, rather than a true biological failure to respond to antidepressants, make depression seem unresponsive to treatment. Up to half of apparent TRD cases may involve such fixable factors. Other overlooked elements contributing to pseudoresistance include adherence issues with medication, insufficient duration or dosing of antidepressants, thyroid dysfunction, bipolar spectrum disorders, ADHD, chronic pain, substance use, and comorbid anxiety.
