At WIP Psychiatry & Ketamine/TMS Center, we treat treatment-resistant depression in Washington, DC, working with patients whose symptoms have not improved with therapy, antidepressants, or prior medication adjustments.
Treatment-resistant depression does not mean untreatable depression—it means the next step should be more structured, more comprehensive, and more individualized.
Our psychiatrists evaluate the full clinical picture, including diagnosis, prior medication trials, medical history, sleep, anxiety, trauma, bipolar spectrum features, substance use, and treatment goals, before recommending a plan.
That plan may include medication management, psychotherapy coordination, IV ketamine therapy, Spravato (esketamine), ketamine assisted psychotherapy (KAP), transcranial magnetic stimulation (TMS), accelerated TMS, or a combination of approaches—adjusted over time based on symptoms, response, and tolerability.
Depression can persist for many reasons. Sometimes the diagnosis needs to be reconsidered. Sometimes the medication strategy has not been optimized. Sometimes depression is complicated by anxiety, OCD, PTSD, ADHD, bipolar spectrum symptoms, chronic stress, or medical factors.
At WIP, we do not treat treatment-resistant depression as a single protocol. We build a treatment plan around the patient.
Treatment-resistant depression (TRD) is generally defined as major depressive disorder that has not improved after two or more adequate antidepressant trials. In practice it often looks like:
For many patients, depression doesn’t fully resolve—it partially improves, then returns, or never meaningfully shifts despite multiple approaches.
Treatment-resistant depression is common: Estimates suggest that up to 30% of individuals with major depressive disorder may experience TRD.
When depression treatment isn’t working, there is usually a reason. Treatment-resistant depression is often not about a lack of options—but about how those options are selected, sequenced, and adjusted over time. Common contributing factors include:
For many patients, the issue is not that nothing works—it’s that the full clinical picture hasn’t been brought together into a structured, evolving plan.
Instead of separating treatments across different providers or settings, we integrate:
You may benefit from a psychiatric evaluation for treatment-resistant depression if:
A structured evaluation can help clarify diagnosis, review prior treatments, and determine whether options such as medication adjustments, ketamine therapy, Spravato, or TMS may be appropriate.
If your current treatment isn’t working, a structured psychiatric evaluation can help clarify your diagnosis, review what’s been tried, and identify the next step—whether that includes ketamine therapy, Spravato, ketamine-assisted psychotherapy (KAP), TMS, or medication management.
WIP Psychiatry & Ketamine/TMS Center serves patients throughout Washington, DC, Maryland, and Virginia, providing integrated care for treatment-resistant depression within a single, coordinated clinical model.
