Question 1

What should I do if antidepressants aren't working?

Accepted Answer

If you've given an antidepressant an adequate trial (typically 6–8 weeks at a therapeutic dose) without meaningful improvement, evidence-based next steps include switching medications, augmentation, structured psychotherapy, and interventional options like TMS, ketamine, or ECT. Bring a complete list of options to your psychiatrist rather than cycling through similar medications by default.

Question 2

What is treatment-resistant depression?

Accepted Answer

Treatment-resistant depression (TRD) is generally defined as depression that has not adequately responded to at least two different antidepressants taken at adequate doses for adequate durations. TRD is common and treatable — options include TMS, ketamine and esketamine, ECT, and specific therapy protocols.

Question 3

Which is better, TMS or ketamine?

Accepted Answer

Neither is universally better. TMS is non-invasive, FDA-cleared for depression, requires no sedation, and is often covered by insurance after medication failures. Ketamine acts faster — often within days — and may help when rapid relief matters, but is usually paid out of pocket except for esketamine (Spravato). The right choice depends on urgency, insurance, medical history, and access.

Question 4

How much does ketamine therapy cost?

Accepted Answer

IV ketamine infusions in the US typically cost $400–$800 per infusion, with an initial series of about six infusions, so roughly $2,400–$4,800 to start, usually out of pocket. Esketamine (Spravato) is FDA-approved and often covered by insurance, which can substantially lower out-of-pocket cost.

Question 5

What types of therapy work for depression?

Accepted Answer

Therapies with strong evidence for depression include cognitive behavioral therapy (CBT), behavioral activation, dialectical behavior therapy (DBT) skills, acceptance and commitment therapy (ACT), and EMDR when trauma is a driver. CBT-I is the first-line treatment when insomnia accompanies depression.

Question 6

What is a stellate ganglion block?

Accepted Answer

A stellate ganglion block (SGB) is an injection of local anesthetic near a bundle of nerves in the neck that helps regulate the fight-or-flight response. It is being used and studied for PTSD symptoms, with several trials showing meaningful symptom reduction. It is a procedure performed by trained physicians, typically anesthesiologists or pain specialists.

Question 7

Is ECT safe?

Accepted Answer

Modern ECT is performed under brief general anesthesia with muscle relaxation and careful monitoring, and is considered one of the most effective treatments for severe depression, with response rates higher than most alternatives. The most common side effects are short-term memory difficulties around the treatment period, which usually improve over weeks.

Question 8

What should I ask my psychiatrist about treatment options?

Accepted Answer

Ask what defines an adequate trial of your current medication, what the next step would be if it fails, whether you meet criteria for TRD, which interventional options (TMS, ketamine/esketamine, ECT) you might qualify for, what insurance would cover, and which therapy modality fits your situation. Bringing a written summary of what you've tried makes the appointment dramatically more productive.

Antidepressants didn't work. That's not the end of the list.

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Treatment guides

Antidepressants Not Working? What to Do Next

What Is Treatment-Resistant Depression?

TMS vs. Ketamine for Depression

How Much Does Ketamine Therapy Cost?

CBT, DBT, EMDR, ACT: Which Therapy Fits?

Stellate Ganglion Block for PTSD

Is ECT Safe? Myths vs. Modern Reality

Questions to Ask Your Psychiatrist

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