Social Snippet & GBP Excerpt: Treatment-resistant depression does not mean you have run out of options when your current treatment has not helped enough. Lightfully Behavioral Health provides personalized mental health treatment for adults living with depression while some specialty treatments require outside medical providers. Click the “Learn more” link to explore five treatment options and questions you can discuss with your care team.

Dr. Nicole Siegfried is a licensed clinical psychologist with more than 20 years of experience in behavioral health and serves as Chief Clinical Officer at Lightfully Behavioral Health. Her work centers on compassionate, evidence-based mental health treatment that recognizes each client as a whole person, not simply a diagnosis.

By Dr. Nicole Siegfried, PhD, CEDS — Chief Clinical Officer, Lightfully Behavioral Health

Depression treatment does not work the same way for everyone. If symptoms continue after treatment, you may feel frustrated or worn down. Treatment-resistant depression does not mean you are out of options. It means your treatment plan may need a closer review or a different approach.

A common definition is depression that has not improved enough after at least two antidepressants were tried at the right dose for enough time. Before changing treatment, a psychiatrist may also look for health conditions, medication problems or another mental health condition that could affect your symptoms.

What happens before your treatment changes?

A careful review can help your care team decide what to try next. Your psychiatrist may ask:

• Did you take the medication at the recommended dose for enough time?
• Did side effects make it hard to take the medication regularly?
• Could another medicine or health problem affect your mood?
• Could bipolar disorder or another condition explain some symptoms?
• What kinds of psychotherapy have you tried?

Treatment-resistant depression is not a personal failure. It means your care team may need more information or a new plan.

Treatment options available for treatment-resistant depression

1. Adjusting or switching antidepressants

Sometimes the next step is still an antidepressant, but with a different approach. A psychiatrist may adjust the dose, give the medication more time to work or suggest a different antidepressant.

Medication decisions are highly individual. Don't change or stop an antidepressant on your own. Your prescriber can look at your symptoms, side effects, other medications and health history before making a change.

2. Adding another medication

A psychiatrist may add a second medication to the treatment plan. This is sometimes called augmentation.

The added medication may be another antidepressant or a medicine from a different drug group. Because combinations can raise the chance of side effects or interactions, a qualified prescriber should guide this approach.

3. Using psychotherapy as part of treatment

Psychotherapy can still help when medication has not helped enough. Cognitive behavioral therapy (CBT), behavioral activation and other approaches may help with negative thinking, avoidance, stress, relationships and daily habits. Medication response is one part of the picture. Depression treatment can also address the thoughts, emotions, behaviors and relationships affecting daily life.

Dr. Nicole Siegfried, PhD, CEDS, explains:

“Therapy is an important treatment because it allows you to work through every facet of severe depression and learn about the root of depressive thoughts, emotions, and behaviors.”

4. Considering esketamine or ketamine

Esketamine is an FDA-approved nasal medication for adults with treatment-resistant depression. It is given in a medical setting because it can cause side effects such as heavy sleepiness or feeling disconnected from yourself or your surroundings. Blood pressure and respiratory status must be monitored, and patients must remain under observation for at least two hours after each treatment.

Ketamine may also be used for depression in some specialty settings. Its use for depression is generally off-label, which means the FDA has not approved ketamine itself for this purpose.

These are specialty medical treatments. They are included here for education and are not Lightfully services.

5. Considering brain stimulation treatments

Brain stimulation may be discussed when depression stays severe after other treatments.

Two options are:

• Transcranial magnetic stimulation (TMS)

A noninvasive treatment that uses magnetic pulses to affect brain areas involved in mood.

• Electroconvulsive therapy (ECT)

A treatment done under anesthesia that uses controlled electrical stimulation to cause a brief seizure. It may be considered for severe or treatment-resistant depression.

TMS and ECT require specially trained medical teams. They are not Lightfully services.

How do these treatment options differ?

These options do not always happen in a set order. Your care team may suggest one or more based on your needs.

• Antidepressant changes

This may involve adjusting the dose or timing of a medication or switching to a different antidepressant. A psychiatrist or another qualified prescriber typically guides these changes.

• Medication addition

This involves adding another medication to the existing treatment plan rather than replacing the antidepressant. A psychiatrist or another qualified prescriber oversees this approach.

• Psychotherapy

Treatment may include CBT or other evidence-based approaches that address thoughts, behaviors, relationships, coping and daily functioning. A licensed mental health clinician provides this support.

• Esketamine or ketamine

These are specialized medication-based interventions that may be considered in certain cases of treatment-resistant depression. They require qualified specialty medical providers and are not being presented as Lightfully services.

• Brain stimulation therapies

Options such as TMS or ECT may be considered when depression has not responded adequately to other treatments. These require specialized psychiatric or medical teams and aren't being presented as Lightfully services.

The right next step depends on your symptoms, safety, daily life, past treatment response, health and preferences.

Where can structured mental health treatment fit?

Some adults with ongoing depression need more support than occasional outpatient visits. Structured treatment can offer more frequent psychotherapy, psychiatric support, skills practice and help with daily routines.

Lightfully uses our Precision Care Model to understand the patterns behind symptoms. Treatment can address thoughts, emotions, behaviors and relationships instead of using the same plan for everyone.

One Lightfully client described their broader treatment experience:

“Lightfully was a life-changing experience. I came here at an all-time low in my life, and I’m leaving at an all-time high. I feel empowered to use all the tools I learned. Every single person here helped me on my recovery journey.” — VB*

Lightfully offers adults several levels of care, including Residential Treatment, Partial Hospitalization Program, also called our Day Treatment Program, Intensive Outpatient Program and Virtual Services.

If depression includes suicidal thoughts, self-harm with safety concerns or another immediate crisis, call or text 988, call 911 or go to the nearest emergency room.

If your current depression treatment is not helping enough, you may still have other options. A new assessment, treatment plan or level of support may help you find a better next step.

Change is possible. When you're ready to take the first step, reach out to our Admissions Concierge Team. We’ll take the next steps together, toward the fullest, brightest version of you.

*This testimonial reflects one client’s experience and does not indicate that the client had treatment-resistant depression or predict another person’s results.

Frequently asked questions

What does treatment-resistant depression mean?

It usually means depression has not improved enough after more than one treatment attempt. Many clinicians use two adequate antidepressant trials as a general reference point.

Does treatment-resistant depression mean depression cannot be treated?

No. It means the treatments tried so far have not helped enough. Other medication, psychotherapy or specialty treatments may still be considered.

How many antidepressants are usually tried first?

Many clinicians use at least two antidepressant trials as a general guide. A psychiatrist also considers the dose, length of treatment and other factors that may affect results.

Can psychotherapy still help?

Yes. Psychotherapy can help with thoughts, behaviors, stress, relationships and coping even when medication has not provided enough relief.

When might treatments such as esketamine or ECT be discussed?

A psychiatrist may discuss them when depression remains severe after other treatments. The best option depends on symptoms, treatment history, health and safety needs.

How do I know if I need treatment for depression?

You may benefit from treatment if persistent sadness, numbness, loss of interest, low energy, sleep or appetite changes and trouble functioning are making it hard to feel like yourself or move through your day. Lightfully looks beyond a diagnosis to understand the thoughts, emotions, behaviors and relationships that may be keeping symptoms going.

What does depression treatment usually focus on?

Treatment often focuses on reducing depression symptoms, building practical coping skills and understanding the patterns underneath your distress. At Lightfully, your treatment plan is personalized through our Precision Care Model so care can meet your unique needs.

Can depression get better with the right support?

Yes, meaningful change is possible with consistent, evidence-based care. The goal is not to define you by depression, but to help you build skills, insight and steadier support for daily life.

What level of care might help with depression?

The right level of care depends on your symptoms, safety needs, schedule and how much support you need right now. Lightfully offers multiple levels of care for adults, including Residential Treatment, Partial Hospitalization Program, Intensive Outpatient Program and Virtual Services.

How can Lightfully help with depression?

Lightfully provides whole-person-centered care that can support motivation, relationships, work, self-care and hope. Your clinicians work with you to create an individualized plan that helps you move toward the fullest, brightest version of yourself.