Treatment-Resistant Depression Treatment in Fort Worth

What is treatment-resistant depression?

Treatment-resistant depression (TRD), sometimes called refractory depression, refers to depression that has not improved adequately despite appropriate treatment.

The term does not mean that depression is untreatable. Rather, it describes a situation in which previous treatment has not produced sufficient or sustained improvement and a more detailed reassessment of the diagnosis, previous treatments, contributing conditions, and available treatment strategies may be needed.

Depression can remain difficult to treat for many reasons. The next step is therefore not simply to try “more” treatment, but to understand the individual clinical picture and determine what approach may be most appropriate.

How do I know if I have treatment-resistant depression?

Treatment-resistant depression is generally used to describe major depression that has not improved adequately despite multiple appropriate antidepressant treatment trials. A commonly used definition is inadequate response to at least two antidepressant treatments given at an adequate dose and duration during the current depressive episode, although definitions vary.

Determining whether depression is truly treatment resistant involves more than counting medications. We review which treatments were tried, the doses and duration, adherence, the degree and duration of response, side effects, and why a treatment was stopped.

We also reassess the diagnosis and consider psychiatric and medical conditions, sleep disorders, substance use, medications, and other factors that may contribute to persistent depressive symptoms or interfere with treatment response.

Having depression that has been difficult to treat does not mean that you have exhausted your treatment options. The purpose of a comprehensive reassessment is to understand what may be contributing to the limited response and determine which treatment strategies may still be appropriate.

What should I do when previous treatment has not relieved my depression?

An inadequate response to antidepressant medication does not mean that there are no treatment options left. It may be useful to reconsider the diagnosis, previous medication trials, side effects, medical conditions, sleep, substance use, psychotherapy, and other factors that may be affecting recovery.

Depending on this reassessment, the next step may involve adjusting medication, incorporating or modifying psychotherapy, considering Deep TMS or IV ketamine, or combining approaches when clinically appropriate.

The choice should be based on your individual treatment history, symptoms, medical considerations, preferences, and goals rather than assuming that the same next step is appropriate for everyone.

Treatment options for treatment-resistant depression

Treatment-resistant depression does not have a single treatment pathway. Some patients come to us after several medication trials, while others have already received treatments such as TMS, IV ketamine, or Spravato® (esketamine) without adequate or lasting improvement.

A limited response to previous treatment does not necessarily mean that depression will not respond to a different approach. We reassess what treatments have been tried, how they were delivered, what response occurred, how long improvement lasted, and what side effects or other factors may have limited treatment.

An important part of this reassessment is determining whether psychiatric or medical conditions that may affect depression and treatment response have been adequately recognized and addressed. Depending on the individual, this may include other psychiatric symptoms or diagnoses, substance use, sleep disorders, medical conditions, medications, and other factors that can complicate recovery.

Treatment may involve a different medication strategy, psychotherapy, Deep TMS, IV ketamine, or a carefully selected sequence or combination of approaches. Previous exposure to one of these treatments does not by itself determine whether another approach—or a different treatment plan incorporating previous and new treatments—may be appropriate.

Our goal is not to assume that depression is “untreatable” because several treatments have not worked. It is to understand why it has remained difficult to treat and develop an individualized strategy based on the diagnosis, contributing conditions, previous responses, medical history, preferences, and treatment goals.

Deep TMS

Deep TMS is a noninvasive treatment that uses magnetic stimulation to influence brain networks involved in depression. Treatment is performed while you are awake and does not require anesthesia.

At our Fort Worth practice, we use BrainsWay® Deep TMS. It can be an important option for people whose depression has not improved adequately with previous treatment, but TMS does not necessarily need to be reserved until multiple treatments have failed. It may also be considered earlier when clinically appropriate, including when medication has not been well tolerated or when a patient prefers to discuss nonmedication treatment options.

We evaluate whether Deep TMS is appropriate based on your diagnosis, symptoms, treatment history, medical considerations, preferences, and applicable device indications.

Learn more about Deep TMS therapy in Fort Worth.

IV ketamine

IV ketamine may be considered for selected patients with treatment-resistant depression. Some patients experience improvement relatively quickly, sometimes within the first day after an infusion. Not everyone responds, and the duration of improvement varies.

IV ketamine for depression is an off-label treatment. Ketamine is FDA-approved as an anesthetic, but it is not FDA-approved for the treatment of depression or other psychiatric disorders.

When considering ketamine, we discuss realistic expectations, potential benefits and risks, previous treatments, medical considerations, and how ketamine compares with other options such as medication, psychotherapy, and Deep TMS.

Learn more about IV ketamine therapy in Fort Worth.

When depression has been difficult to treat

If you have tried multiple treatments without adequate or lasting improvement, the next step does not necessarily have to be simply repeating what has already been tried. A comprehensive psychiatric reassessment can help identify factors that may have affected previous treatment and clarify which options remain appropriate.

At the Institute for Advanced Psychiatry in Fort Worth, we evaluate patients at different stages of treatment—from those considering their next option after antidepressant medication to those who have already received treatments such as TMS, ketamine, or Spravato®.

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You can also learn more about our approaches to Depression Treatment, Deep TMS Therapy, and IV Ketamine Therapy.