What is treatment-resistant depression?
Treatment-resistant depression, often shortened to TRD, generally means depression that has not responded adequately to at least two different antidepressants, each taken at a proper dose for a long enough time. It does not mean untreatable. It means the standard first moves did not work and a more deliberate plan is needed. We cover this in depth in our guide to treatment-resistant depression.
How do I know if my antidepressant is working?
Most antidepressants need roughly six to eight weeks at an adequate dose before anyone can judge them. Signs it may not be the right fit include no change at all after a full trial, partial relief that stalls short of feeling like yourself, side effects that outweigh any benefit, or core symptoms like sleep, energy, and interest staying untouched. Track your dose and how you feel, and bring that record to your doctor. There is more in our guide on the signs your antidepressant isn't working.
How long should I give an antidepressant before deciding it isn't working?
A fair trial is usually an adequate dose taken consistently for about six to eight weeks. Side effects can appear before any benefit, so the first couple of weeks are not informative. Contact your prescriber sooner if your mood drops sharply, you feel more agitated, or you have any thoughts of harming yourself.
What is Spravato and how is it different from a regular antidepressant?
Spravato is the brand name for esketamine, a nasal spray derived from ketamine and FDA-approved in 2019 for treatment-resistant depression. It works through the glutamate system rather than serotonin, and some people notice a shift in days rather than weeks. It is given in a certified clinic with about two hours of monitoring afterward, you cannot drive yourself home that day, and it is usually taken alongside an oral antidepressant.
What is the difference between Spravato and IV ketamine?
Spravato (esketamine) is FDA-approved for treatment-resistant depression and is frequently covered by insurance. IV ketamine for depression is used off-label, meaning the drug is approved for anesthesia and used for depression based on clinical evidence rather than a specific FDA depression approval. Off-label IV ketamine is often paid out of pocket and protocols vary more between clinics. Our newer treatments guide walks through both.
What is TMS and does it use medication?
TMS, or transcranial magnetic stimulation, uses no medication. During a session you sit in a chair while a device near your scalp delivers focused magnetic pulses to a mood-related brain region. It is FDA-cleared for treatment-resistant depression. A course usually runs several days a week over several weeks, you stay awake and alert, and most people drive themselves to and from appointments.
Does insurance cover Spravato in Missouri?
Because Spravato is FDA-approved and delivered in a certified clinic, it is frequently covered by insurance, including many commercial plans, and TMS is also commonly covered for treatment-resistant depression. Off-label IV ketamine is often not covered. Coverage usually requires prior authorization showing prior antidepressants did not work. Your specific plan is the final word, so confirm benefits directly with the clinic and your insurer. See our Missouri coverage guide for details.
Does MO HealthNet cover treatment-resistant depression treatments?
MO HealthNet is Missouri's Medicaid program. Do not assume you are excluded because you are on MO HealthNet. Some Missouri clinics that focus on treatment-resistant depression accept it. Coverage for a specific treatment depends on your situation and program rules, so the reliable way to know is to ask the clinic and your plan directly.
What treatments work best for PTSD?
The treatments with the strongest evidence for PTSD are specific trauma-focused therapies: Cognitive Processing Therapy (CPT), Prolonged Exposure (PE), and EMDR. Certain antidepressants, particularly SSRIs, also help, especially alongside therapy. PTSD is one of the more treatable mental health conditions when the right, structured treatment is used. Our PTSD guide covers where to begin.
What should I ask my doctor if my antidepressants aren't working?
Ask whether your last medication was at a full dose for a full trial, whether they would switch classes, augment, or try a different kind of treatment, and whether you are a candidate for TMS or Spravato. Also ask whether anything else, such as sleep, thyroid, or alcohol, could be working against your treatment. Bring a one-page history of every medication you have tried and what happened. We have a full script in our guide on how to talk to your doctor.
Where can I get treatment-resistant depression care near St. Louis?
Brain Recovery Centers is a doctor-supervised clinic in St. Charles County serving the greater St. Louis area, focused on treatment-resistant depression and PTSD with FDA-approved esketamine (Spravato) and TMS. They accept most insurance, including MO HealthNet. Confirm coverage and candidacy directly with the clinic.
Brain Recovery Centers
A doctor-supervised clinic in St. Charles County serving greater St. Louis, focused on treatment-resistant depression and PTSD with FDA-approved esketamine (Spravato) and TMS.
Most insurance accepted, including MO HealthNet.
Disclosure: Brain Recovery Centers is our recommended partner for readers in the St. Louis region. Confirm coverage and details directly with the clinic.