You’ve tried medication after medication, and the fog still hasn’t lifted. That’s not a personal failure. It’s a medical reality with a name: treatment-resistant depression. The good news is real. Two treatments, Spravato and TMS, are helping people find relief when standard antidepressants fall short.
Both are available through Autumn Leaves Psychiatry, and both come with strong evidence behind them.
What Counts as Treatment-Resistant Depression?
Doctors generally define treatment-resistant depression this way. It’s major depression that hasn’t improved after two or more antidepressant trials at the right dose. It’s more common than most people realize. The National Institute of Mental Health ran a landmark STAR*D study on this exact problem. Researchers found that many patients need several treatment strategies before finding real relief. Each additional medication trial gets harder. The odds of success can drop with every attempt. That’s exactly why other options exist.
Option 1: Spravato (Esketamine)
Spravato is a nasal spray medication approved for treatment-resistant depression. It works differently from traditional antidepressants. Most pills target serotonin. Spravato acts on a different brain pathway, called NMDA receptors. It can start easing symptoms within hours or days, not weeks.
Treatment happens in the clinic under medical supervision. You’ll receive the nasal spray, then stay for monitoring afterward. Sessions typically run twice a week at first, then taper down as your provider adjusts your plan.
Spravato works well for patients who’ve cycled through multiple antidepressants without success. It also helps people who need faster relief, especially those dealing with severe symptoms.
Option 2: Transcranial Magnetic Stimulation (TMS)
TMS takes a completely different approach. Instead of medication, it uses magnetic pulses to stimulate specific areas of the brain linked to mood regulation. The FDA approved TMS for depression back in 2008. It now helps thousands of patients across the country every year.
A typical TMS session lasts around 12 to 25 minutes. You sit in a comfortable chair while a coil delivers pulses to your scalp. There’s no sedation and no downtime. You can drive yourself home afterward and return to your day.
Many patients complete a course of 20 to 36 sessions over several weeks. Reported success rates are strong, with a large share of patients experiencing significant relief from their symptoms.
TMS is a great fit for patients who want a non-drug option or who can’t tolerate medication side effects.
Which Treatment Is Right for You?
There’s no universal answer here. The right choice depends on your history, your symptoms, and your goals. Some patients even combine approaches under a provider’s guidance.
The most important step is talking with a psychiatric provider who knows your full treatment history. They can walk you through the details and help you weigh the tradeoffs honestly.
Ready to Explore Your Options?
You don’t have to keep guessing your way through treatment. Contact Autumn Leaves Psychiatry today to schedule a consultation and find the path that actually works for you.
Frequently Asked Questions
How do I know if I have treatment-resistant depression?
If you’ve tried two or more antidepressants at proper doses for at least six weeks each, and still haven’t improved, you may meet the clinical definition. A psychiatric evaluation can confirm this and rule out other factors affecting your response to treatment.
Is Spravato or TMS covered by insurance?
Many insurance plans, including Medicare and some Medicaid plans, cover both treatments for patients who meet treatment-resistant depression criteria. Coverage details vary by plan, so it’s worth confirming your specific benefits before starting treatment.
How long do the effects of Spravato or TMS last?
Results vary by person. Some patients maintain improvement for months after finishing a TMS course, while others benefit from occasional maintenance sessions. Spravato often requires an ongoing maintenance schedule that your provider will personalize based on how you respond.