Depression treatment FAQ

Treatment-resistant depression usually means depression that has not improved after trying at least two different antidepressants at an adequate dose for an adequate length of time. It does not mean nothing will help. It means it is time to look at other approaches, such as adjusting medication, adding structured therapy, or considering newer supervised options like TMS or esketamine. Our guide on when antidepressants aren't working goes deeper.

Esketamine, sold under the brand name Spravato, is an FDA-approved prescription nasal spray for adults with treatment-resistant depression. Unlike a daily antidepressant pill you take at home, esketamine is given in a certified clinic under supervision, with about two hours of monitoring afterward and a ride home arranged. It works through a different pathway in the brain than traditional antidepressants and is usually added alongside an oral antidepressant. See our esketamine guide.

TMS (transcranial magnetic stimulation) is a non-drug, FDA-cleared treatment for depression that uses focused magnetic pulses to stimulate a mood-related area of the brain. You sit awake in a chair and feel a tapping sensation on your scalp. It is not painful for most people, though some feel mild scalp discomfort or a headache early on that fades. There is no sedation and no recovery time, so you can drive yourself home or to work afterward. Our TMS guide has more.

No. TMS and ECT are different treatments. TMS uses gentle magnetic pulses while you are fully awake, requires no anesthesia, and does not cause memory loss. ECT is an older treatment performed under anesthesia. People often confuse the two, but a TMS session is closer to sitting in a dentist chair than to a hospital procedure.

Because both esketamine and TMS are FDA-approved or cleared for treatment-resistant depression, many insurance plans in Missouri cover them, though plans usually require documentation that other antidepressants were tried first. Coverage can include MO HealthNet through providers who accept it. The clearest way to confirm is to ask a clinic that offers the treatment to verify your specific plan before you start.

Ordinary sadness tends to ease as life moves on. Depression lasts most of the day nearly every day for two weeks or longer, shows up in your body and thinking as well as your mood, and does not lift much even when good things happen. If a low or empty mood, loss of interest, sleep or appetite changes, and low energy are getting in the way of work, family, or daily life, it is worth talking to a professional. See depression symptoms and when to get help.

First, make sure each medication had a fair trial at the right dose and for enough time, and that other issues like thyroid problems, poor sleep, or an incomplete diagnosis are not in the way. Then book a visit specifically to discuss what is next, not just a refill. If you have tried two or more medications without relief, ask your provider directly whether TMS or esketamine could fit your situation, or seek a clinic that specializes in treatment-resistant depression.

Yes. PTSD and depression often occur together, and good treatment addresses the whole picture rather than one piece. Trauma-focused therapy and certain medications are front-line options for PTSD, and clinics that treat treatment-resistant depression frequently see patients whose depression and trauma overlap. It is fair to ask a provider directly whether they have experience treating both. Our PTSD treatment guide covers the options.

If you are in crisis or having thoughts of suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline. It is free, confidential, and available 24 hours a day. If you or someone else is in immediate danger, call 911. Veterans can call or text 988 and then press 1 for the Veterans Crisis Line.

Yes. Community behavioral-health providers in St. Charles County and the greater St. Louis area offer outpatient therapy and psychiatry, and many accept MO HealthNet or offer sliding-scale fees based on income. If a provider does not take your insurance, it is reasonable to ask whether they offer a sliding scale. Our local directory lists several real options to start with.