What is treatment resistant depression?

Treatment resistant depression refers to major depression which has not responded to at least 2 antidepressants at an appropriate dose & duration. Usually, treatment resistant depression will be diagnosed after 2 first line antidepressants have been tried at an appropriate dose for a minimum of 6-8 weeks (Cleveland Clinic). This term simply refers to a pattern in the way the depression is presenting. It does not mean there is nothing that can help you & indicates that we need to take a closer look at your treatment plan. Find out more about treatment resistant depression & how we treat it at Calm Clarity.

How common is treatment resistant depression?

Approximately 30% of people with major depressive disorder will develop treatment resistant depression following antidepressant medications (Cleveland Clinic). American Family Physician state that approximately 31% will develop treatment resistant depression & only around 1/3 will respond to their first antidepressant. The National Institute of Mental Health estimate that 21.0 million adults in the US (8.3% overall) had at least one major depressive episode in the most recent survey year. In Colorado, 23.0% of adults have been told by a healthcare professional they have a depressive disorder (America's Health Rankings).

Why antidepressants don't always work

Antidepressants do not always work due to not being on a high enough dose, not having been tried for long enough, not taking the medication regularly or not having the correct diagnosis. Before any patient is labelled as treatment resistant, it is important to ensure medication compliance has not been the issue (American Family Physician) which can affect up to 46% of patients. Low mood can also be caused by bipolar, ADHD, trauma, poor sleep or substance use.

How is treatment resistant depression diagnosed?

To diagnose treatment resistant depression, we must ensure there were 2 appropriate antidepressants tried. We would then take a full reassessment to ensure the dose, duration & compliance were correct & reassess the diagnosis. Many definitions are used to define treatment resistant depression & the most commonly used definition is failure to respond to two or more regimens of antidepressants at an appropriate dose, duration & compliance (World Psychiatry Journal). Having a team working together can help this, as we can look at your medication history with medication management with a PMHNP-BC & investigate patterns within your therapy.

How can I be treated?

You can be treated with antidepressant switching, augmentation, psychotherapy, rTMS, ECT & esketamine. American Family Physician state you may require augmentation with agents such as second generation antipsychotics & lithium. Throughout treatment, individual therapy can be provided using techniques such as CBT, DBT & ACT. If you like being outside, we can provide walk & talk therapy. Your treatment will depend on your history.

What is Spravato (esketamine)?

Spravato (esketamine) is an FDA approved nasal spray medication for adults with treatment resistant depression. It can only be administered within a REMS certified setting & under the supervision of a healthcare professional. Esketamine is a medication that is given in a monitored clinical setting (American Family Physician). Johnson & Johnson announced on the 21st January 2025 that Spravato had been approved by the FDA as the first monotherapy for adults with treatment resistant depression. Over 140,000 patients globally have had Spravato so far (Johnson & Johnson). Calm Clarity can provide Spravato through a REMS certified programme led by Lisa DeMay (PMHNP-BC).

Who can have Spravato & how do I get started?

Spravato can be prescribed to adults with treatment resistant depression. Every patient will have an initial consultation at our Denver location. Spravato can only be provided at our Denver location as we are a certified REMS treatment center. You can continue seeing your external providers & our intake team will complete prior authorisation. If you have any thoughts of self-harm/suicide please contact or text our crisis line provided by Calm Clarity Therapy. In an emergency please contact emergency services. Find out more about our process on our Spravato (esketamine) page.

Can it get better?

Whilst treatment resistant depression can be a challenging pattern to overcome, many people will see improvement once their treatment plan has been reassessed & further steps have been added. Over 100 million people globally have one or more definitions of treatment resistant depression (World Psychiatry Journal). Rates of suicidality are disproportionately higher in this group, therefore it is important to stay connected to your treatment. If you're in crisis, call 911 or the 988 Suicide & Crisis Lifeline.. Often building resilience to this is about adding an extra layer of support.

Getting support in Denver, Lakewood & throughout Colorado

To get support we will begin by having an honest reassessment of what has been tried & what your next step will be. Calm Clarity Therapy provide medication management & therapy services in Denver & Lakewood. We can also provide these sessions via telehealth throughout Colorado. We work with patients in Denver, Lakewood & Aurora. Everyone has a different journey with their depression & there is no 'right' pace. When you're ready you can contact us to book a Spravato consultation. Our intake team will check your benefits (Aetna, BCBS, Select Health & Health First Colorado (Medicaid)) prior to your first appointment.