What we treat
Depression that hasn’t responded yet
If you’ve tried two or more antidepressants without enough relief, you have what’s clinically called treatment-resistant depression. It’s not a personal failure. And it’s not the end of the road.
You’re not the problem
About a third of people with depression don’t get full relief from standard antidepressants. That doesn’t mean you didn’t try hard enough or take the medicine wrong. It’s the biology of how depression works in some brains. The treatments below were specifically developed for the situation you’re in.
What’s available
Spravato (esketamine) — coming soon to Northline
Approved by the FDA in 2019 specifically for treatment-resistant depression. Spravato is the first new class of antidepressant in roughly 30 years. It works on a completely different system in the brain than SSRIs and SNRIs — which is why it can help when those haven’t.
In the major studies, 50–70% of people with treatment-resistant depression respond, and 30–50% reach full remission. Many people start to feel different within days rather than weeks.
TMS — Transcranial Magnetic Stimulation — coming soon to Northline
FDA-cleared for treatment-resistant depression since 2008. Non-invasive brain stimulation. No medication, no anesthesia. About 20 minutes a day for 6–9 weeks. 50–60% response, 30–40% full remission.
Adding to your existing medication
Sometimes the right move is adding a second medication to the antidepressant you’re already on, rather than switching. Several FDA-approved options exist (aripiprazole, brexpiprazole, quetiapine XR), as well as classic strategies like lithium augmentation. Your clinician will talk through which makes sense for you.
Specialty referral when needed
For severe treatment-resistant depression where Spravato and TMS aren’t right or haven’t worked, ECT (electroconvulsive therapy) remains a highly effective option. We refer to academic medical centers in Connecticut when ECT or other specialty treatments are warranted.
First, we make sure we’ve got the diagnosis right
Before pursuing advanced treatment, we want to confirm the picture. That means looking carefully at your history:
- Were the previous antidepressants at the right dose for long enough?
- Are there other conditions contributing — anxiety, trauma, sleep apnea, thyroid issues, substance use?
- Is there something different going on entirely (bipolar disorder, for example) that calls for a different approach?
This isn’t gatekeeping. It’s making sure that when we do something more, we’re doing the right something.