You went to the appointment.
You tried the medication.
You gave it time.
Maybe you tried another medication after that. You may have added therapy, changed routines, or made other adjustments recommended by your healthcare provider.
But depression is still affecting your life.
When you have already put time and effort into treatment without experiencing enough improvement, it is understandable to feel frustrated or discouraged.
But previous treatments not providing enough relief does not necessarily mean you have run out of options.
For some people, ongoing depression may be considered treatment-resistant depression, and additional treatment approaches may be worth discussing with a healthcare provider.
Depression Treatment Does Not Work the Same Way for Everyone
Depression is complex.
Two people with similar symptoms may respond very differently to the same medication.
Some people experience significant improvement with the first treatment they try. Others may need to adjust medication, change medications, participate in therapy, or combine several approaches.
Finding the right treatment can take time.
For some people, symptoms continue despite trying multiple antidepressant treatments.
That experience can be discouraging, but it can also provide healthcare providers with important information about what to consider next.
What Is Treatment-Resistant Depression?
Treatment-resistant depression generally refers to major depressive disorder that has not adequately improved after at least two appropriate antidepressant treatments.
Symptoms may continue to include:
- Persistent sadness
- Loss of interest in activities
- Low energy
- Difficulty concentrating
- Changes in appetite
- Changes in sleep
- Difficulty completing everyday responsibilities
- Feelings of hopelessness
- Withdrawal from relationships or activities
The word “resistant” can make the situation sound permanent, but that is not what the term means.
Treatment-resistant depression describes how depression has responded to treatments so far. It does not mean that every available treatment has failed or that there are no additional options to discuss with a healthcare provider.
Why Might Your Treatment Plan Need to Change?
If depression symptoms continue, your healthcare provider may want to take another look at the overall picture.
That conversation may include:
- Which antidepressants you have tried
- How long you took each medication
- Medication dosage
- Side effects
- How consistently medication was taken
- Current symptoms
- Other mental health conditions
- Physical health conditions
- Sleep patterns
- Substance use
- Major stressors or life changes
- Your experience with therapy
These details can help your provider determine whether the current treatment should be adjusted or whether another approach should be considered.
Additional Treatment Options May Be Available
Traditional antidepressants are not the only approach to depression treatment.
Depending on your individual circumstances, a healthcare provider may discuss options such as:
- Adjusting your current medication
- Trying a different medication
- Combining medications
- Individual therapy
- More structured behavioral health treatment
- Additional treatments designed for treatment-resistant depression
One treatment that may be considered for eligible adults is Spravato® (esketamine).
Spravato is an FDA-approved prescription nasal spray used for certain adults with depression, including treatment-resistant depression.
Spravato acts on NMDA receptors, which are part of the brain’s glutamate system. The exact way esketamine produces its antidepressant effects is not fully understood.
For treatment-resistant depression, it may be used on its own or with an oral antidepressant based on the patient’s individual treatment plan.
What Does Spravato Treatment Involve?
Spravato is not a prescription you take home.
Treatment is provided in a SPRAVATO REMS-certified healthcare setting under medical supervision.
Patients self-administer the nasal spray under the direct observation of a healthcare provider and remain at the facility afterward so their healthcare team can monitor them.
Potential side effects can include:
- Sedation
- Dissociation
- Dizziness
- Nausea
- Increased blood pressure
Respiratory depression has also been reported. Because of these risks, patients are monitored by a healthcare provider for at least two hours during each treatment session. Respiratory status is also monitored during treatment, including with pulse oximetry.
Patients should arrange transportation home after treatment and should not drive, operate machinery, or perform activities requiring full alertness until the next day after a restful sleep.
Spravato is not appropriate for everyone. A healthcare provider must evaluate your medical history, previous treatments, current medications, and other factors before determining whether it may be an option.
Depression Treatment Is About More Than Medication
Medication can play an important role in treating depression, but comprehensive behavioral health care may include several forms of support.
At Pathway Healthcare, individualized behavioral health services may include:
- Psychiatric evaluations
- Medication management
- Individual therapy
- Intensive Outpatient Programs
- Virtual Intensive Outpatient Programs
- Ongoing psychiatric care
- Spravato treatment for eligible adults at select locations
Treatment plans are developed based on each person’s symptoms, history, circumstances, and goals.
For some people, that means medication and therapy.
For others, it may mean exploring a different level of care or another treatment option.
Talk Honestly With Your Provider About What Is Not Working
It can be tempting to tell your provider that you are “fine” or assume you simply need to give treatment more time.
Your provider needs to understand what you are actually experiencing.
Consider starting a conversation if:
- Your symptoms have not improved
- You have experienced only limited improvement
- Side effects are difficult to manage
- Depression continues to interfere with work or relationships
- Everyday responsibilities still feel difficult
- You feel discouraged about your progress
- You want to understand whether other treatment options are available
You do not have to know which treatment you need before having that conversation.
Your healthcare provider can help you evaluate the options.
Telehealth Can Help You Stay Connected to Care
Depression itself can make scheduling and attending appointments feel difficult.
Pathway Healthcare offers telehealth for many behavioral health services, making it possible for eligible patients to receive care from home.
Virtual services can help reduce transportation barriers and make appointments easier to fit around work, family, or other responsibilities.
In-person care is also available when face-to-face appointments are preferred or required for a particular treatment.
Spravato treatments themselves must take place in a SPRAVATO REMS-certified healthcare setting because patients need to be monitored after receiving the medication.
Previous Treatments Are Part of the Story, Not the End of It
Trying several depression treatments without experiencing enough improvement can be exhausting.
It can also make it harder to believe another approach could be worth exploring.
But mental health treatment is not always a straight line.
Sometimes progress involves reevaluating what has already been tried, understanding what is still not working, and having a different conversation with your healthcare provider.
At Pathway Healthcare, our behavioral health providers work with patients to understand their symptoms, treatment history, and individual needs while exploring appropriate options for continued care.
If depression has continued despite previous treatment, consider talking with a healthcare provider about what you have tried and what other options may be available.
