Treatment-Resistant Depression

Treatment-resistant depression (TRD) is generally used to describe major depressive disorder that has not responded adequately to appropriate trials of antidepressant medications. While definitions vary, many healthcare providers consider depression to be treatment-resistant when symptoms continue despite trying two or more antidepressants prescribed at appropriate doses and durations.

No. Treatment-resistant depression does not mean that recovery is impossible. It simply means that traditional treatments have not provided adequate relief. Many individuals experience significant improvement after a comprehensive psychiatric evaluation and an individualized treatment plan that may include additional evidence-based treatment options.

There is no single laboratory test for treatment-resistant depression. Diagnosis begins with a comprehensive psychiatric evaluation that reviews your symptoms, previous medications, treatment history, medical conditions, and other factors that may be contributing to ongoing depression. Confirming the diagnosis is an important first step before considering additional treatment options.

There is no one-size-fits-all answer. Many treatment guidelines define treatment-resistant depression as depression that has not responded adequately to two or more appropriate antidepressant trials. However, every patient's situation is unique, and treatment recommendations should always be individualized following a comprehensive psychiatric evaluation.

There are many reasons depression may not respond as expected, including an incorrect diagnosis, co-occurring medical or mental health conditions, medication side effects, inadequate treatment duration or dosing, or true treatment-resistant depression. A comprehensive psychiatric evaluation can help identify contributing factors and determine the most appropriate next steps.

Depending on your individual history and clinical needs, treatment may include medication adjustments, psychotherapy referrals, lifestyle modifications, or advanced treatment options such as Spravato® (esketamine), Transcranial Magnetic Stimulation (TMS), or IV ketamine therapy for appropriate patients. Your provider will discuss which options may be suitable for your specific situation.

Yes. Spravato® (esketamine) is approved by the U.S. Food and Drug Administration (FDA) for adults with treatment-resistant depression and must be administered in a certified healthcare setting under the FDA Risk Evaluation and Mitigation Strategy (REMS) program. Your provider will determine whether Spravato® is an appropriate treatment option based on your diagnosis and treatment history.

Transcranial Magnetic Stimulation (TMS) is an FDA-cleared, non-invasive treatment for certain individuals with depression who have not responded adequately to antidepressant medications. Following a comprehensive psychiatric evaluation, your provider can determine whether TMS may be an appropriate option for your individual circumstances.

Yes. Although both therapies are related, they are different medications and are administered differently. Spravato® contains esketamine and is FDA approved for treatment-resistant depression under a REMS program. IV ketamine is administered intravenously and may be considered for appropriate patients based on a comprehensive psychiatric evaluation and clinical judgment. Your provider can discuss the differences, potential benefits, and considerations of each treatment.

If you continue to experience symptoms of depression despite trying appropriate treatments, or if depression is significantly affecting your work, relationships, or quality of life, it may be time to schedule a comprehensive psychiatric evaluation. If you are experiencing thoughts of self-harm or are in immediate danger, call 911, go to the nearest emergency department, or call or text 988 to reach the Suicide & Crisis Lifeline.

Most patients do not need a referral to schedule an appointment, although some insurance plans may require one. Our office can help verify your insurance benefits before your first visit.