What Is Treatment-Resistant Depression?
I’ve seen this over and over in practice—patients who have done “everything right.”
They’ve tried medications. Sometimes several.
They’ve gone to therapy.
They’ve pushed through.
And yet… they’re still struggling.
Treatment-resistant depression (TRD) is typically defined as depression that has not improved after trying at least two appropriate antidepressant medications.
But let’s be honest—labels only go so far.
What matters is this:
If you’re still suffering despite treatment, we need to look deeper and think differently.
Why Does Depression Become “Resistant”?
In my experience, TRD is rarely about “nothing working.”
It’s often about something important being missed.
We look at contributors such as:
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Underlying medical conditions (thyroid, hormonal, metabolic)
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Nutritional deficiencies (B12, folate, vitamin D, iron)
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Chronic stress or unresolved trauma
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Sleep disruption
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Medication mismatch or incomplete response
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Substance use or medication interactions
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Inflammation and gut-brain factors
Depression is not always just a neurotransmitter issue.
Sometimes it’s a whole-system issue.
Our Approach to TRD
At Catoosa Behavioral Health and Wellness Clinic, we don’t jump straight to “the next medication.”
We step back and ask:
👉 Why hasn’t this improved yet?
Our approach includes:
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Careful review of past treatments (what helped, what didn’t, and why)
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Targeted lab evaluation when appropriate
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Thoughtful medication adjustments—not trial-and-error prescribing
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Integration of physical and mental health
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Collaboration with therapy providers when needed
We believe medications are tools—but not the only tool.
When Standard Treatments Aren’t Enough
For some patients, even with a comprehensive approach, symptoms persist.
That’s when we begin to consider advanced treatment options.
Spravato® (Esketamine) – A New Option for TRD
One of the most important developments in recent years is Spravato, an FDA-approved treatment specifically for adults with treatment-resistant depression.
Unlike traditional antidepressants, which can take weeks to work, Spravato acts on a different system in the brain (the glutamate pathway) and may provide more rapid symptom relief for some patients.
What to Know About Spravato
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Administered as a nasal spray in a certified medical setting
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Used alongside an oral antidepressant
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Requires monitoring after each treatment (typically about 2 hours)
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Given on a structured schedule (initially more frequent, then spaced out)
Who May Benefit
Spravato may be appropriate for individuals who:
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Have tried multiple antidepressants without adequate relief
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Continue to experience significant depressive symptoms
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Are seeking alternatives beyond traditional medications
Important Considerations
Spravato is not a quick fix—and it’s not for everyone.
It requires:
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Careful screening
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Ongoing monitoring
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Commitment to the treatment process
Our role is to help determine:
👉 Is this the right next step—or is something else being missed?
A Thoughtful, Stepwise Approach
I believe strongly in this:
Just because something is newer or more advanced doesn’t mean we skip the basics.
At the same time…
No one should stay stuck when there are other options available.
We help you navigate both.
You Don’t Have to Keep Guessing
If you’ve been living with depression that hasn’t improved despite treatment, it may be time for a different approach.
Not rushed.
Not one-size-fits-all.
Not just “try another medication and see.”
Let’s Take a Closer Look—Together