When depression continues despite treatment, another appointment can feel like another request to start from the beginning. You may remember the side effects more clearly than the medication names. You may wonder whether a brief improvement counted, or whether ongoing symptoms mean you have run out of options.
At Eudaimonia Psychiatric Mental Health Clinic, we begin by making room for that history, including the parts that were frustrating or difficult to explain. Our conversations about care for depression are not about deciding whether you tried hard enough. They are about understanding what you have experienced and what deserves a closer look.
Treatment-resistant depression is a clinical description, not a verdict about your future. Before discussing another treatment, we need to understand what that description means in your particular situation.
What does treatment-resistant depression mean?
The term commonly describes depression that has not responded adequately to at least two antidepressant trials. Those trials need to involve an appropriate dose taken for enough time. But counting prescriptions is not enough. An international consensus on difficult-to-treat depression calls for a broader assessment. That includes diagnosis, previous care, other difficulties, daily functioning, and your priorities (McAllister-Williams et al., 2020).
That distinction matters. A medication stopped early because of severe side effects tells us something different from one taken consistently without meaningful benefit. Partial improvement also deserves attention: sleeping better while still being unable to work is not the same as feeling well.
We would not ask you to diagnose treatment resistance from a checklist. We would ask what changed, what did not, and what each treatment actually involved.
We reconstruct the treatment history, not just the medication list
A useful assessment gives each previous treatment some context. We may ask:
- What was the medication, and how did the dose change?
- How long did you take it at the prescribed dose?
- Which symptoms improved, if any?
- What side effects or practical barriers made continuing difficult?
- Why was it stopped, changed, or combined with something else?
- What other care did you receive during that period?
There is no need to arrive with a perfect record. Pharmacy histories, old visit summaries, and your own recollections can help us build a timeline. If you cannot remember a name, “the one that made me too sleepy to drive” is still a useful starting point.
We also want to understand access. A refill gap because of insurance is not the same experience as taking a medication continuously. Please tell us about cost, scheduling, or instructions that were hard to follow. We need that information to understand your care, not to judge it.
The evaluation looks beyond persistent low mood
We ask how your symptoms have changed over time. When did they begin? Were there periods of relief? What was happening around major changes? We also ask about safety, physical health, substance use, sleep, and your ability to manage everyday responsibilities.
Questions about unusually elevated or irritable moods belong in this conversation too. So do times when you needed much less sleep or behaved in ways that felt out of character. Our assessment of mood-related concerns includes experiences you may not initially connect with depression.
If difficulty sleeping is dominating your nights, tell us what that actually looks like. Are you awake until morning, waking repeatedly, or sleeping for long stretches without feeling rested? Specific descriptions help us decide what to explore further.
We may use symptom questionnaires alongside the conversation. We also ask about ordinary markers of daily life: preparing a meal, answering messages, getting to work, or enjoying time with someone you care about. We want the assessment to reflect your life, not only a score.
How assessment shapes treatment options for treatment-resistant depression
The next step is not automatically a newer treatment. It may be a clearer understanding of an earlier trial, a revised diagnosis, or a discussion about a different strategy. A review of emerging depression treatments describes a growing range of approaches. It also highlights differences in their evidence, risks, and clinical use (Marwaha et al., 2023).
For some people, the discussion includes changing medication or adding another medication to an existing plan. A review of combination and augmentation strategies found evidence supporting several approaches. It also noted important limits and differences among the studies (Scott et al., 2023). That does not make any one combination the right choice for everyone.
Care discussions may also include referral for a specialized evaluation. We explain which services we provide, which would require referral, and why an option is being considered. You should not have to infer those distinctions from a list of treatment names.
Where SPRAVATO® may enter the discussion
We offer SPRAVATO® for treatment-resistant depression. Considering it begins with an individual evaluation, not simply the number of medications you have taken.
Evidence includes a trial alongside an oral antidepressant that evaluated changes in depressive symptoms and treatment safety (Popova et al., 2019). More recently, a randomized monotherapy trial evaluated esketamine without an oral antidepressant in adults with treatment-resistant depression (Janik et al., 2025). These findings inform the discussion; they cannot predict your individual response.
SPRAVATO® is administered in person under direct observation in a REMS-certified healthcare setting. Patients are monitored afterward according to the program’s requirements, for at least two hours. It is not a take-home or video-visit treatment. Before proceeding, we discuss medical history, safety considerations, possible side effects, transportation, and the appointment commitment. Whether it belongs in your plan remains an individual decision.
Leave with a plan you can explain in your own words
Our approach to care leaves room for questions, uncertainty, and preferences. Before an appointment ends, we want you to understand what we are assessing, what information is still missing, and what happens next.
You might ask, “Why are you recommending this step?” or “What would make us reconsider?” Those are useful questions, not obstacles to care. You can contact our team to begin that conversation without having already chosen a treatment.
If you are having suicidal thoughts or need immediate emotional support, call or text 988 to reach the suicide and crisis lifeline (988 Suicide and Crisis Lifeline, n.d.). If there is immediate danger, call 911 or go to the nearest emergency department.
Works Cited
1. McAllister-Williams RH, et al. The identification, assessment and management of difficult-to-treat depression: An international consensus statement. 2020. https://pubmed.ncbi.nlm.nih.gov/32217227/
2. Marwaha S, et al. Novel and emerging treatments for major depression. 2023. https://pubmed.ncbi.nlm.nih.gov/36535295/
3. Scott F, et al. Systematic review and meta-analysis of augmentation and combination treatments for early-stage treatment-resistant depression. 2023. https://pubmed.ncbi.nlm.nih.gov/35861202/
4. Popova V, et al. Efficacy and Safety of Flexibly Dosed Esketamine Nasal Spray Combined With a Newly Initiated Oral Antidepressant in Treatment-Resistant Depression: A Randomized Double-Blind Active-Controlled Study. 2019. https://pubmed.ncbi.nlm.nih.gov/31109201/
5. Janik A, et al. Esketamine Monotherapy in Adults With Treatment-Resistant Depression: A Randomized Clinical Trial. 2025. https://pubmed.ncbi.nlm.nih.gov/40601310/
6. 988 Suicide and Crisis Lifeline. https://988lifeline.org/
Disclaimer
This article is for educational purposes only and is not a substitute for individualized evaluation, diagnosis, or treatment from a qualified healthcare professional.