Depression that does not respond to 2 or more antidepressant medications of therapeutic dose for at least 6 weeks is what I call “sticky depression” or more formally, treatment resistant depression. Luckily it does not have to be treatment resistant anymore because I have 2 major weapons against “sticky depression” - Transcranial Magnetic Stimulation (TMS) and Spravato (esketamine nasal spray). Luckily, both are very safe, FDA approved/cleared, and are covered by most major insurance plans. Often, the biggest challenge is deciding which treatment is best for my individual patient because most patients are great candidates for both treatments.