If you are in crisis, call or text 988. The 988 Suicide and Crisis Lifeline answers 24 hours a day. In an emergency, call 911.
What counts as treatment-resistant
Depression is usually called treatment-resistant when it has not improved enough after at least two different antidepressants, each taken at an adequate dose for long enough to work. It is common: many people with major depression do not get full relief from their first or second medication.
Treatment-resistant does not mean untreatable. It means the next step is usually a different kind of treatment, not another medication of the same type.
Signs
You may be dealing with treatment-resistant depression if:
- you have taken two or more antidepressants as prescribed and your mood has improved little or not at all
- a medication helped at first and then stopped working
- side effects have forced you to stop medications before they could help
- you feel somewhat better but still cannot work, sleep or enjoy things as you used to
Only a clinician can make the diagnosis. Other conditions, such as thyroid problems, sleep disorders or bipolar disorder, can look like depression that will not lift, and they need different care.
Options
- TMS therapy. Magnetic stimulation of the area of the brain that regulates mood. Not a drug. Short weekday sessions for several weeks, and you can drive afterwards.
- Spravato. An FDA-approved nasal spray for treatment-resistant depression, taken in our office with a two-hour monitoring period.
- Ketamine. A medication given under supervision that can act quickly. Its use for depression is off-label.
Our comparison page sets the three side by side.
How we decide
We start with your history: which medications you have taken, at what dose and for how long, and what happened. A clinician then looks at your diagnosis, your other health conditions and medications, how your week is arranged, and what your insurance covers. From that we recommend where to start and explain why. The decision is yours.
These treatments work best as part of your wider care. We encourage you to keep seeing your therapist and prescriber, and with your permission we keep them informed.
Insurance
Most plans cover TMS and many cover Spravato for treatment-resistant depression, usually after a record of the antidepressants you have tried. We check your coverage before you start. See insurance and cost.
If you are in crisis
If you are thinking about harming yourself, do not wait for an appointment. Call or text 988 to reach the Suicide and Crisis Lifeline at any hour, or call 911 or go to the nearest emergency room. We are an outpatient clinic and are not an emergency service.
Frequently asked questions
How many medications do I need to have tried?
The usual definition is at least two antidepressants, each at an adequate dose for an adequate time. Insurance plans set their own number, often two to four, before they cover TMS or Spravato.
Do I have to stop my antidepressant?
Usually not. Most people stay on their medication during TMS, Spravato or ketamine treatment. Any change is made with your prescriber.
Which treatment works best?
There is no single best treatment. Each helps some people and not others, and the right starting point depends on your history, your health and your coverage. That is what the first call and evaluation are for.
How soon can I start?
It depends on the evaluation and on how long your insurer takes to approve treatment. We start the coverage check as soon as you contact us.