Antidepressant medication and psychotherapy are often effective for depression, but they don’t work equally well for everyone. Depression that continues despite appropriate treatment, such as at least two antidepressants, is known as treatment-resistant depression (TRD).
Studies show that around 70% of patients with treatment-resistant depression who initially improve with standard antidepressants relapse within six months.
At Labyrinth Psychiatry Group, we treat depression with established approaches including medication and psychotherapy, while also offering targeted treatments such as transcranial magnetic stimulation (TMS) and esketamine for people whose symptoms haven’t responded adequately to standard care.
Depression is complex; it has multiple potential causes, and different people can respond very differently to the same treatment.
Antidepressants alter chemical signaling associated with mood and stress, but finding an effective medication can take time. There are several classes of these drugs, with varying types within each class. Furthermore, most antidepressants need around four to eight weeks to produce their full effects.
Some people experience partial improvement rather than remission. Others find that a medication works initially but doesn’t control their symptoms long-term. Side effects can also make some treatments challenging to stick with.
Before changing direction, we review your symptoms, previous treatments, medication response, and overall mental health. Treatment resistance doesn’t mean that depression can’t be treated. Instead, it tells us that we may need to use a different strategy.
Medication can play an important role, even when previously prescribed antidepressants haven’t worked. We may consider a different type of antidepressant or use a medication from another drug class with your original medication to improve the response.
Psychotherapy can also help you address thought patterns, behaviors, stress, relationships, and other factors that contribute to depression.
For most people, combining different treatment approaches works better than relying on one means alone. However, if these methods still don’t provide enough relief, targeted treatments offer another path.
Transcranial magnetic stimulation uses repeated magnetic pulses to stimulate specific networks in the brain involved in mood regulation. TMS doesn’t require surgery, anesthesia, or sedation. During treatment, you remain awake while a magnetic coil rests against your scalp.
We commonly use TMS for people with depression who haven’t responded adequately to antidepressant medication. Treatment usually involves a series of outpatient sessions rather than a single procedure.
TMS acts directly on brain circuits rather than circulating medication throughout the body. Common side effects can include temporary scalp discomfort or headache, but treatment doesn’t require a recovery period, and patients generally return to their usual activities afterward.
Esketamine, sold under the brand name Spravato®, also takes a different approach from conventional antidepressants. It’s a nasal spray that affects the brain’s glutamate system through N-methyl-D-aspartate (NMDA) receptors.
The FDA approves esketamine for adults with treatment-resistant depression. Current prescribing information allows us to use it either as a standalone treatment or with an oral antidepressant.
Research has shown that esketamine can begin reducing depressive symptoms much faster than conventional antidepressants. In a clinical study analyzing its use as a standalone treatment, researchers detected improvement approximately 24 hours after treatment began.
You can’t take esketamine home for unsupervised use because it can cause side effects, including:
You must receive each dose in a certified healthcare setting like Labyrinth Psychiatry, where our clinical team monitors you for at least two hours after your treatment.
TMS and esketamine both treat depression that’s difficult to manage, but they work in different ways. One isn’t necessarily better than the other.
We consider factors including:
Some people continue medication or therapy while receiving a targeted treatment. Your treatment plan may also change depending on how your symptoms respond.
Continuing depression after several treatments signals that it’s time to reassess the treatment approach rather than repeat what hasn’t worked.
At Labyrinth Psychiatry Group, we offer medication management, psychotherapy, TMS, and esketamine treatment for depression. If your symptoms haven’t improved despite antidepressant treatment, call or message our Cranford or Edison, New Jersey, office today to discuss which approach may be best for you.
