If you’ve tried antidepressants or therapy in the Washington, DC area without improvement, you may be experiencing treatment-resistant depression, a condition that requires a more personalized treatment approach. However, this is a clinical diagnosis and shouldn’t be determined based on research alone. While we can provide you with helpful information, it’s important for you to speak to a board-certified psychiatrist to diagnose and treat your symptoms. It’s also important to note that just because something is “treatment-resistant” does not mean there is no path to find relief.
In this guide going over treatment-resistant depression (TRD), we’ll discuss the following:
Treatment-resistant depression (TRD) is defined as those that are diagnosed with depression and have tried multiple antidepressants, but are all deemed ineffective. According to Johns Hopkins Medicine, “Treatment-resistant depression affects about 30% of people diagnosed with major depressive disorder.” It can feel much more constant, with little to no relief throughout a person’s day-to-day life. At times, you might see slight improvements in your mood, but they can quickly fade, leading to frustration in your recovery journey.
Columbia Mental Health notes that a key difference between treatment-resistant depression (TRD) and typical depression is that TRD might not have any “off days.” It can feel much more constant, with little to no relief throughout a person’s day-to-day life. At times, you might see slight improvements in your mood, but they can quickly fade, leading to frustration in your recovery journey.
Even if you are doing everything right, from journaling and attending appointments consistently to taking your medication on a daily basis, it still might not feel like progress is being made. That feeling of having tried everything, yet nothing seems to provide a long-term solution, can be a sign that you may be dealing with TRD rather than typical depression. However, it’s extremely important to receive this diagnosis from a psychiatrist and not self-diagnose.
There are times when certain depression treatments may not work for an individual. Multiple underlying factors can contribute to this, including misdiagnosis, genetics, an inadequate treatment plan, or substance use.
Before a psychiatrist makes a diagnosis of treatment-resistant depression, they may allow more time for a medication to take effect, switch to a different medication, or adjust the dosage to assess whether there is any improvement. After several trials of various treatments, a psychiatrist may diagnose one with TRD if:
Being told your depression is “treatment-resistant” can feel overwhelming. It may sound like a dead end, but it isn’t. In reality, this diagnosis often signals the need to explore different or more advanced treatment approaches rather than stopping treatment altogether.
There are options beyond traditional antidepressants that have shown promising results for individuals with TRD. Two of the most commonly discussed alternatives are Transcranial Magnetic Stimulation (TMS) and ketamine therapy. These approaches work differently from standard medications and may be considered when other treatments have not provided relief; however, it’s important to note that a treatment that works for one, might not work for another. Results may vary on how effective a treatment is per person, and you need to remain patient and work with a professional to determine what’s best for your individual needs.
Ketamine acts on the brain’s glutamate system, enhancing synaptic plasticity and restoring communication between neural networks that can become disrupted in depression and trauma. It can work within hours to days and is typically administered through IV or intranasal dosing, often one to two times per week in the short term.
The National Library of Medicine conducted a study on the role of ketamine in treatment-resistant depression. They determined that “Ketamine [has shown to be] rapidly effective and was associated with a significant clinical improvement in depressive symptoms within hours after administration.” Additionally, ketamine has been found to help reduce suicidality in TRD.
One of the aspects that makes ketamine distinct from traditional antidepressants is how quickly it may take effect. While many antidepressants can take weeks to show results, ketamine has been observed to work within hours to days in some individuals. It is typically administered through IV infusion or intranasal dosing, often one to two times per week in the short term under medical supervision.
To learn even more about the differences between ketamine infusion and Spravato (intranasal dosing), check out our blog on Spravato vs. Ketamine Infusion: Which Treatment Is Right for You? We also have a resource that goes over what to do before and after a ketamine fusion, as well as one that goes into the safety of IV infusion.
TMS (Transcranial Magnetic Stimulation) is a non-invasive, FDA-approved treatment for depression that uses magnetic pulses to stimulate specific areas of the brain associated with mood regulation.
Unlike medication-based treatments, TMS does not require sedation and is not associated with systemic side effects. This can make it an appealing option for individuals who either have not responded to medications or prefer a non-drug approach to treatment. TMS is also performed while a person is awake and does not typically impact memory or cognitive functions.
According to the National Library of Medicine, TMS has demonstrated response rates of approximately 60–70%, with remission rates between 30–40% in individuals with depression.
Our team at WIP wrote a blog that goes into more details about the main differences of ketamine and TMS for depression, which we encourage you to check out if you are considering participating in one of these alterative medicines.
At WIP Psychiatry & Ketamine/TMS Center (WIP), we offer a full spectrum of care—from medication management to advanced treatments like ketamine therapy and TMS. This comprehensive approach allows you to work with the same psychiatrist throughout your entire treatment journey, ensuring continuity of care and a more personalized experience as you navigate treatment-resistant depression.
Our board-certified team is able to both diagnose and treat you within the same practice, helping streamline the process and reduce the stress of coordinating care across multiple providers. In some cases, we also offer virtual appointments when an in-office visit is not necessary, providing additional flexibility while maintaining the quality of your care.
We currently have an office location in Washington, DC. While many of our psychiatrists provide care remotely, they are available to be on-site whenever in-person treatment is required. Our services are available to all residents of Washington, DC, Maryland, and Virginia.
Our TRD psychiatrists are here to help you find hope, even when your diagnoses may feel discouraging. Contact our team today with any questions you might have.
