Treatment Resistant Depression When to Try Advanced Options
Feeling stuck even after trying more than one antidepressant is scary. You are not alone. Treatment Resistant Depression means your symptoms have not improved enough after at least two well tried treatments. The good news is that there are safe advanced options that can help when standard care is not enough. Large studies show many people need more than one step before they feel well, so needing a next step is common and solvable. (National Institute of Mental Health)
What treatment resistant depression means
Doctors use the term Treatment Resistant Depression when you have major depressive disorder and two or more adequate treatment trials did not bring full relief. Adequate means the right dose, taken long enough, with good follow up. In a landmark study funded by the National Institute of Mental Health, about one third of people reached full remission with the first medicine. Another group improved after a second step. By four steps almost seven in ten who stayed in care reached remission, though each step became harder. This shows why a planned step up path matters. (National Institute of Mental Health)
Signs it may be time to step up care
- You tried two antidepressants long enough and at the right dose and still feel low or stuck. (National Institute of Mental Health)
- You get a little better then slip back again.
- Side effects stop you from taking helpful doses.
- Depression is blocking school work or relationships.
- You need faster relief because symptoms feel severe. If you are in danger call or text 988 for the Suicide and Crisis Lifeline now. (National Institute of Mental Health)
Advanced options at a glance
- Transcranial magnetic stimulation, often called TMS. A non medicine therapy that uses brief magnetic pulses to activate brain circuits tied to mood. Cleared by the Food and Drug Administration for depression after other treatments have not helped. (U.S. Food and Drug Administration)
- Esketamine nasal spray, brand name Spravato. An in clinic medicine that works on the glutamate system. In 2025 the FDA expanded approval so Spravato can be used by itself for adults with treatment resistant depression. (accessdata.fda.gov)
Next you will find plain language detail on each option plus how our team at MindBodySoul in Decatur and across metro Atlanta helps you choose.
TMS explained
TMS uses a medical device placed on the scalp to create a focused magnetic field. That field turns on and off very fast. It creates a tiny current in a small brain area that helps reset mood circuits over time. Sessions are done in an outpatient chair. You are awake. No anesthesia is needed. (U.S. Food and Drug Administration)
A typical plan includes brief weekday sessions over several weeks. People can drive themselves to and from most visits. Many feel only scalp tapping or mild headache that fades. A rare seizure can occur, though expert reviews show the risk is low when safety rules are followed. (National Institute of Mental Health)
Who TMS helps
- Adults with major depression who did not improve enough with antidepressants
- People who cannot tolerate side effects of medicines
- Teens age fifteen to twenty one can receive TMS as an add on treatment with certain FDA cleared systems. Ask us about this if your family needs help. (accessdata.fda.gov)
Learn more on our TMS pages. See NeuroStar TMS Therapy on the MindBodySoul site. See our partner pages on advanced therapy and TMS care for adults and teens.
• NeuroStar TMS Therapy at MindBodySoul
• Advanced therapy for mental health
• TMS for depression
• TMS for adult depression
• TMS for adolescent depression
Esketamine Spravato explained
Esketamine is a form of ketamine delivered as a nasal spray in a certified clinic with trained staff. It acts on glutamate pathways to lift mood. In January 2025 the FDA expanded the label so Spravato can be used alone for adults with treatment resistant depression. That means doctors now have more choices to tailor care. Dosing and monitoring follow a safety program that includes observation in the clinic after each dose. (accessdata.fda.gov)
Important safety note
The FDA warns that compounded ketamine products for mental health are not approved and can carry risks, especially without in clinic monitoring. Esketamine Spravato is the only ketamine related product approved for depression and must be given under supervision in a certified setting. (U.S. Food and Drug Administration)
If you want to explore Spravato with our regional partner, start here
How we tailor care at MindBodySoul in Decatur and across metro Atlanta
You deserve a plan that fits your life and symptoms. Here is how we build it with you.
- Telehealth evaluation across Georgia for new patients. We review your history, current symptoms, past medicines, therapy, and goals. We confirm whether your case fits Treatment Resistant Depression and map next steps.
- In person care in Decatur for treatments. We provide TMS on site. We guide you to Spravato through our partner center when that is the right path.
- Measured care. We use simple rating tools to track symptoms each week. This approach helped many people reach remission in the large NIMH study and it guides our choices too. (National Institute of Mental Health)
- Whole person support. We coordinate with your therapist and primary care. We help with sleep, routine, and relapse prevention.
Learn more about our psychiatric care services here
What to expect if you start TMS with us
- Consultation visit to confirm fit and discuss your goals
- Motor threshold mapping to set your personalized treatment level
- Short weekday sessions that fit your schedule in Decatur
- Progress checks to track gains and adjust as needed
- A taper or maintenance plan if you and your clinician decide it can help
Cost and insurance basics
Many insurers, including Medicare, cover TMS for major depressive disorder when clear criteria are met. Coverage rules vary by plan, but Medicare policy outlines when TMS is considered reasonable and necessary. Our team helps you check benefits and submit needed notes. (cms.gov)
When to choose which option
- Start with a review of your first two steps. Were doses high enough and taken long enough. Did you have therapy support. If not, fixing these can help. (National Institute of Mental Health)
- If you still have Treatment Resistant Depression, consider TMS as a strong next choice. It is non medicine, non surgical, and well tolerated. (National Institute of Mental Health)
- If you need medicine that works through a new pathway, ask about Spravato. FDA approval now allows use as monotherapy for adults with treatment resistant depression, giving more flexibility. (accessdata.fda.gov)
- If symptoms are severe or urgent, talk about ECT for faster action. (National Institute of Mental Health)
- If many steps have failed over years, VNS may be discussed with a specialist. (National Institute of Mental Health)
Care close to home
MindBodySoul serves Decatur, Atlanta, and nearby areas for in person treatments. We offer telehealth across Georgia for evaluations. You can start from home, then come to our Decatur clinic for TMS or other in person care. Your next step for Treatment Resistant Depression can begin today.
Ready to talk with a clinician
Visit our NeuroStar TMS Therapy page on the MindBodySoul site or our psychiatric mental health page. We will help you choose a clear path forward.
Helpful resources
- NIMH STAR D results on stepwise remission rates and the value of measurement based care. (National Institute of Mental Health)
- NIMH overview of brain stimulation therapies including ECT, TMS, and VNS. (National Institute of Mental Health)
- FDA guidance on rTMS systems and clearance history. (U.S. Food and Drug Administration)
- FDA Spravato label and 2025 approval letter for monotherapy use in adults with treatment resistant depression. (accessdata.fda.gov)
- FDA warnings about compounded ketamine for psychiatric use. (U.S. Food and Drug Administration)
- Medicare coverage policy reference for TMS. (cms.gov)
