Treatment Resistant Depression (TRD) and Suicidal thoughts

When Depression Does Not Respond to Standard Treatment

For some individuals, depression persists even after trying therapy, medication, or both. This is known as treatment-resistant depression, and it can leave you feeling discouraged, exhausted, or unsure where to turn next.

At My Care Clinic, we understand how isolating it can feel when standard treatments have not provided relief. Our providers specialize in evaluating and treating complex, persistent depression, including situations involving thoughts of suicide, so you can find a path forward that actually works for you.

What Is Treatment-Resistant Depression?

Treatment-resistant depression (TRD) generally refers to major depressive disorder that has not improved after trying at least two different antidepressant medications at adequate doses and duration. It does not mean your situation is hopeless. It means your treatment plan needs to be reevaluated and adjusted.

TRD can involve:

• Symptoms that persist despite medication changes
• Partial improvement that plateaus
• Depression that returns after initial response
• Ongoing low mood, hopelessness, or fatigue
• Difficulty functioning at work, school, or home
• Thoughts of death or suicide

If you have tried multiple treatments without lasting relief, a specialized evaluation can help identify what has been missed and what options remain.

Understanding Suicidal Thoughts

Thoughts of suicide can occur alongside depression and other mental health conditions. These thoughts can range from passive thoughts of not wanting to be alive to more active thoughts of ending one’s life.

Experiencing these thoughts does not mean something is wrong with you as a person. It means your brain and body are struggling, and that struggle deserves clinical attention and support.

If you are currently having thoughts of harming yourself or are in crisis, please reach out immediately:

• Call or text 988 to reach the Suicide & Crisis Lifeline (24/7, free and confidential)
• Call 911 or go to the nearest emergency room
• Maryland Crisis Hotline: 1-800-422-0009 (available 24/7)
• DC Crisis Hotline: 1-888-793-4357 (available 24/7)

Our Approach to Treatment-Resistant Depression

When standard treatments have not worked, our providers take a more comprehensive look at your history, biology, and circumstances to identify why.

Comprehensive Reevaluation

We review your full treatment history, past medications, dosages, and response patterns to identify what has and has not been tried.

Diagnostic Clarification

Sometimes what looks like TRD is influenced by an underlying condition that has not been fully addressed, such as bipolar disorder, anxiety, trauma, a medical condition, or substance use.

Advanced Treatment Options

Depending on your history and needs, treatment may include:

• Medication adjustments or combination strategies
• Genetic testing (GeneSight®) to guide medication selection
• Spravato® (esketamine) treatment for treatment-resistant depression
• Individual therapy alongside medication management
• Coordination with other specialists when appropriate

Safety Planning

When suicidal thoughts are present, developing a personalized safety plan is a central part of care. This may include identifying warning signs, coping strategies, support contacts, and steps to take during a crisis.

Who This Treatment Is For

This specialized care may be appropriate if you:

• Have tried two or more antidepressants without lasting improvement
• Have experienced depression that keeps returning
• Are experiencing thoughts of suicide or self-harm
• Feel that your current treatment is not working
• Want a more thorough evaluation of your treatment history
• Are looking for additional options beyond standard medication

Spravato® for Treatment-Resistant Depression

Spravato® is an FDA-approved nasal spray medication specifically indicated for adults with treatment-resistant depression, including those with depressive symptoms and suicidal thoughts. It works differently than traditional antidepressants and may provide relief for individuals who have not responded to other treatments.

Learn more about Spravato® treatment

You Are Not Out of Options

Treatment-resistant depression and suicidal thoughts can make it feel like nothing will help. But there are additional evaluations, treatments, and strategies that have not yet been tried. A thorough, personalized reassessment can uncover a path forward, even after previous treatments have not worked.

If you are struggling with persistent depression or thoughts of suicide, reach out to My Care Clinic. You do not have to face this alone, and help is available.