Treatment-resistant depression
In Sacramento, when two or more antidepressants have failed, TMS and Spravato are the next step.
The definition
What counts as treatment-resistant depression?
Depression is considered treatment-resistant when at least two different antidepressants, each taken at an adequate dose for an adequate length of time, have failed to produce an adequate response. That is the standard definition, and it is also the specific threshold most insurers use to approve TMS.
The phrase is unfortunate, because it sounds like a verdict on the person. It is not. It is a description of what a particular set of medications did, and roughly one in three people with major depressive disorder end up in this category. Failing two antidepressants is common, not exceptional.
What it actually means practically is that the next step is probably not a third pill. Once two medications have not worked, the odds that a third one will are meaningfully lower, and treatments that act through a different mechanism become the better bet.
Do you qualify?
Signs you may already meet the criteria
You do not need a formal diagnosis of treatment-resistant depression to be evaluated. If any of these describe your experience, bring them to a consultation and we will work out where you actually stand.
- 1
You have taken two or more antidepressants for at least six weeks each, at a real dose, and still feel largely the same.
- 2
Something helped at first and then stopped working, so the dose kept getting raised without much changing.
- 3
The side effects were the reason you stopped, not the depression lifting. Weight, sleep, or libido made the trade not worth it.
- 4
Nobody has ever measured your symptoms with a standardized score, so nobody can actually say whether anything worked.
Common questions
Questions about treatment-resistant depression
If your question is not here, call (916) 800-4363 and a person will answer.
The two most established options are TMS therapy and Spravato, both FDA-cleared or approved for exactly this situation. TMS uses magnetic stimulation with no medication involved. Spravato is a nasal spray taken under supervision in our office. Which one fits depends on urgency, what you have already tried, and your medical history, and sometimes a physician will use both.
Remission is a realistic goal, not a fantasy. Many patients who did not respond to multiple medications do reach remission with TMS or Spravato. What we will not do is promise you a specific outcome. We will measure your symptoms at every visit so you can see for yourself whether it is working, rather than relying on anyone’s impression.
Usually, yes, and the failed medication trials are precisely what unlocks coverage. Most commercial plans, Medicare, and Sutter Health Plan cover TMS once two antidepressants have failed. Spravato is generally covered with prior authorization. We verify your benefits and file the authorization for you before anything is scheduled.
No. Duration of illness does not disqualify anyone, and we regularly treat people who have been unwell for a decade or more. A long history means the evaluation matters more, because we want to understand what has been missed rather than repeat it.
Do not stop anything on your own. TMS is typically done while you continue your current medication, and stopping abruptly can cause withdrawal effects. Any change to your medication is a decision your provider makes with you, at a pace that is safe.
Modern Minds Health treats treatment-resistant depression at 4440 Duckhorn Dr, Suite 420, Sacramento, CA 95834, in Natomas, with free parking at the door. We see patients from across the region including Roseville, Elk Grove, Citrus Heights, Folsom, Rancho Cordova, Arden-Arcade, and West Sacramento. Call (916) 800-4363 for a free consultation.
Two failed medications
is not the end of the list
Bring what you have already tried to a free consultation. A provider will tell you where you actually stand and what is still available to you.