Order and disorder: Navigating narrative tensions in the experience of treatment resistant depression.

A significant proportion of people with depression do not experience expected recovery following treatment with antidepressant medication and are considered to have treatment resistant depression. Despite this, there is relatively little research exploring the experiences of this group of people, who represent a significant minority of those who experience depression. The current study addressed this gap in the literature by exploring how people with treatment resistant depression understand and make sense of depression that has not resolved following adherence to professional advice and treatment. A narrative approach was adopted, with a particular focus on personal stories told by participants and interpersonal stories co-constructed between the participants and the interviewer. The accounts of nine people with treatment resistant depression recruited from a private psychiatry and psychology practice in Auckland, New Zealand were analysed. Two narratives were identified: first, a narrative of order was used to organize and make sense of their experiences, which was informed by wider clinical psychology assumptions and expectations of recovery. Second, a narrative of disorder was used to describe the persistence of depressive symptoms and the difficulty they experienced predicting and responding to these experiences. Across these accounts, there was a general pattern of participants drawing on the narrative of order when storying early experiences of depression and, after outlining experiences that disrupted these ordered constructions, drawing on the narrative of disorder when storying later experiences. However, this pattern was not strict. Instead, a narrative tension emerged, with the participants repeatedly switching back and forth between the two narratives. Ultimately, the participants used both narratives to make sense of and account for their experiences of treatment resistant depression.