Effective Treatments for Treatment-Resistant Depression

depressed man

As one of the most common mental disorders, millions of Americans struggle with depression. While therapy can be a powerful healing tool, it may not alleviate day-to-day symptoms for everyone. Most people try antidepressants to manage daily symptoms, but this doesn’t always work. As many as one-third of individuals with depression don’t find relief from standard antidepressants. Beyond that, they often come with a variety of side effects that can be significantly debilitating. Luckily, there are alternative options for those with treatment-resistant depression that are safe and effective. These three options can help people find long-lasting relief from their depression:

Transcranial Magnetic Stimulation

TMS, or Transcranial Magnetic Stimulation, is a non-invasive method that uses magnetic pulses to stimulate neural activity in the brain. It has been used in clinical trials since the 1980s and was approved by the FDA as a treatment for depression in 2008. TMS targets specific areas of the brain, such as the basal ganglia which is related to depression, to relieve symptoms in over 60% of patients. It is effective for various types of depression, including chronic and major depressive disorder as well as bipolar disorder. TMS can also be used to treat other mental conditions like OCD, anxiety, PTSD, and smoking cessation by targeting different areas of the brain.

TMS is considered a safe treatment option with minimal risks. The most significant risk is a seizure, which occurs in less than 0.01% of patients. People with a history of seizures or metal implants may not be eligible for TMS. The side effects of TMS are usually mild and include a knocking sensation or scalp sensitivity during treatment and mild headaches. These side effects usually subside after each session and decrease in intensity as the treatment progresses.

One of the key advantages of TMS is that it provides long-lasting results. Unlike standard antidepressants, which lose their effect once medication is stopped, TMS can provide lasting relief. A standard treatment course typically consists of 30 sessions over 6 weeks. Many patients who respond to the treatment will experience relief from depression symptoms for months or even years.


Ketamine treatment for depression has recently gained popularity and may have come across it. Originally used as an anesthetic, the FDA approved the first ketamine treatment for depression in 2019, in the form of esketamine or s-ketamine, available as a nasal spray under the brand name Spravato. Other forms of ketamine are also available, such as intravenous infusions, rapid dissolve tablets, and intramuscular injections. Some forms of ketamine can be self-administered at home.

All forms of ketamine treatment for depression are considered safe and can be highly effective for those with treatment-resistant depression. This is because ketamine works differently from traditional antidepressants by affecting the brain’s glutamate production, which is believed to be a cause of depression. Additionally, ketamine starts making lasting changes in the brain immediately after the first dose, and enables the brain to regrow lost neural connections. Unlike other antidepressants that stop working when discontinued, a single dose of ketamine can trigger long-term symptom relief.

A typical ketamine treatment plan includes six infusions or sessions over 2-3 weeks. If you are working, check if this is covered by your employer’s health insurance. More than half of patients will show improvement after the first dose, and many continue to experience relief for several months after the treatment is completed. Additional follow-up doses can be given to prolong the effects of ketamine.

depressed man


Neurofeedback is a non-invasive therapy that doesn’t use any drugs. It aims to retrain the brain to address persistent negative thought patterns. During the therapy, electrodes are used to monitor brain waves in real-time, and microcurrents are applied in response. By monitoring brain activity, patients can identify specific patterns associated with positive thoughts and negative thoughts and feelings such as anxiety and depression. The microcurrent feedback prompts the brain to change its patterns of activity, leading to long-term changes.

A typical neurofeedback treatment plan includes 1-2 therapy sessions per week until the patient experiences significant improvement. Like the other treatments, additional “booster” sessions can be scheduled to enhance the treatment’s effectiveness. During the neurofeedback sessions, patients can relax in a comfortable chair and remain still for a few moments. The electrodes do not cause any discomfort or pain, the microcurrents they produce are not perceptible to the individual, but the brain responds to the current and makes adjustments accordingly.

IASIS microcurrent feedback is a well-known form of neurofeedback that uses shorter sessions compared to other types of neurofeedback, resulting in fast outcomes. Many patients experience meaningful improvement after only three IASIS microcurrent feedback sessions.

The process of altering brain wave patterns can be applied to various mental health conditions, not just depression. Neurofeedback is commonly used to treat anxiety, PTSD, OCD, ADHD, and many other conditions.


Contrary to popular belief, there are many alternative treatment options for depression that do not involve antidepressant medication. Treatments such as TMS, ketamine, and neurofeedback have the potential to revolutionize mental health care by providing patients with safe and effective, non-addictive and drug-free alternatives. For individuals who are facing challenges with depression that doesn’t respond to antidepressants, there are still options available.

TMS, ketamine, and neurofeedback are three highly promising treatment options that are safe, effective and do not promote daily medication dependence. These treatments are accessible at certified mental health clinics like Bespoke Treatment as a part of a tailored mental health treatment plan.