Hi Listen

It is particularly distressing seeing a loved one suffer with depression and for a long time. My limited understanding of depression is that there can be a variety of causes, experiences, and presentations and therefore no one solution works for everybody. Furthermore a lot of solutions to depression seem to help to some extent but may not result in full remission.

Given this I think the thing is to persist with a number of available resources. Firstly I think you should consider sticking primarily to evidence-based methods - no point in endlessly experimenting things that have initial appeal but have no sound research to back them up. Here are some suggestions:

Exercise - cardiovascular exercise seems to be very helpful, and in women including resistance training may also be helpful - but it has to be regular and sustained. For a good review a have a look at:
Exercise for depression
This review is positive but isn't coming out in strong favour of exercise. that may be more to do with the poor quality of the clinical trials rather than the lack of effectiveness of exercise. Exercise may well be as good or even better than an effective antidepressant. I think the big problem with exercise is for the depressive person taking to it and adhering enough to get and maintain benefits. Your mother might need a lot of support to do this eg a personal trainer who is empathetic and initially takes the initiative

psychotherapy - not all therapies are of the same value. Non specific counselling - if that is what she is receiving doesn't have much evidence for it. Cognitive behavioural therapies (CBT) and interpersonal therapy have received the most scrutiny and are shown to be effective therapies. So making sure your mother is receiving an evidence-based therapy by a qualified therapist is important. And if one isn't working try something and someone else. In CBT there are different varieties with evidence: Classic CBT has recieved the most but there is also one called Acceptance and Commitment therapy which seems promising and one called behavioural activation which emphasises doing! There is one for very entrenched chronic depression called Cognitive behavioural analysis System which appears have good results particularly when combined with medication. One thing I would NOT suggest is trying out self help gurus like Robbins, books and courses. While these may vie people and initial high they can also lead to blaming the patient (and often increase self blaming and self loathing) when their “powerful, life changing” ideas and simplistic solutions don’t work. These approaches are prey on the vulnerable and come down to making money, not good evidence for their effectiveness.

Medication - this receives the most attention and funding yet seems to be more elusive in offering answers than it is often understood. For example there was that recent review that suggests the newer antidepressants are no better than placebo except when delivered to severely depressed individuals. Clinical lore tends to suggest that just because you don’t respond to one doesn’t mean you won’t respond to another. Combining medications may also be helpful. Given your mother has persistent depression is she under the care of a psychopharmacologist? If what she is on isn’t working it may be time to try something else.

If she has already have tried a number of these things your mother may have refractive or resistant depression – just really difficult to find something that helps. By the nature of the beast one very quickly can be come despondent about trying different things.

All the best with helping your mother