So You Have Treatment Resistant Depression - What Do You Try Next?
By Brittany Albright MD, MPH
We feel you. You are the reason we went into the mental health field because we believe you don’t need to keep suffering. We will keep finding and trying new, safe, evidence based treatments until you feel better.
Depression is extremely complex. The first step is to conduct a comprehensive medical and psychiatric evaluation to understand your medical history, symptoms, and treatment history before making any treatment recommendations. This would involve a physical examination, psychiatric evaluation, and a review of your medical and psychiatric history. Often, we recommend baseline screening labs at Sweetgrass Psychiatry to rule out any potential medical causes of depression such as hypothyroidism, vitamin deficiencies, or substance use disorders.
If you are like many of my patients, you have tried several different medication and psychotherapy modalities without success. I am here for you! At Sweegrass Psychiatry, we are proud to offer ground breaking treatments for major depression with clinically significant improvements in depression symptoms, often when our patients have failed so many other medication treatments.
Two of our favorite evidence-based treatments for depression that we offer at our Mount Pleasant, SC location are Spravato / esketamine and transcranial magnetic stimulation (TMS). Both transcranial magnetic stimulation (TMS) and Spravato (esketamine) are FDA-approved treatments for treatment-resistant depression. However, the choice of treatment depends on several factors, such as the severity of your symptoms, the duration of the treatment-resistant depression, your medical history, your schedule, your insurance benefits, your ability to obtain rides, and your personal preferences.
TMS is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain. It is typically administered over several weeks, with daily treatments lasting about 20-30 minutes. TMS has shown promising results in reducing depressive symptoms, particularly in patients who have not responded to other treatments such as medication or therapy.
Spravato is a nasal spray that is used in conjunction with an oral antidepressant. It is administered in a healthcare provider's office, and patients are monitored for at least 2 hours after receiving the medication. Spravato works by targeting a different neurotransmitter system in the brain compared to traditional antidepressants. It has also shown positive results in treating treatment-resistant depression. The Spravato treatment course is 2x per week for 4 weeks followed by 1x per week x4 weeks then maintenance treatments as needed / as directed by your physician. The TMS treatment course is typically 18 min treatments, 5 days per week x6 weeks. You can drive to and from your TMS appointments and there is no downtime, unlike Spravato.
In general, TMS may be preferred in patients who prefer non-pharmacological treatments or have a history of medication intolerance, stroke, cardiovascular issues, pregnancy or side effects. Spravato may be preferred in patients who require more rapid relief of depressive symptoms and who have adequate and reliable transportation to and from our Isle of Palms, SC office or Mount Pleasant, SC office.
Affordability is important. We offer Spravato and TMS at Sweetgrass Psychiatry as most major insurances including Tricare, Medicare, Aetna, Cigna, United, Optum, Humana, and BCBS often cover both treatments., Most patients have to pay copayments for treatment and some may be subject to meeting their insurance annual deductible. We have a billing department at Sweetgrass Psychiatry that can perform a vertication of benefits for you upon request.
Side effects are important. In general, TMS and Spravato are both very well tolerated treatments but both can have completely different side effects. Example - TMS may initially cause scalp discomfort or a mild, transient headache. Spravato may cause slightly elevated blood pressure and dissociation or feeling “high” which resolves within the 2 hour in office monitoring period. Contact an expert at Sweetgrass Psychiatry today to discuss the different side effects, risks, and benefits of each treatment.
Ultimately, the choice between TMS and Spravato should be made based on a collaborative decision between you and your treating psychiatrist. It is essential to discuss the potential risks, benefits, and side effects of each treatment option before making a decision.
Please call Sweegrass Psychiatry today at (843) 800-1303 to schedule a consultation with one of our psychiatric providers today to determine if Spravato or TMS would be a good treatment option for you. You don not have to suffer from depression anymore -effective, safe affordable and accessible treatment is here!