Treatment-resistant depression

Many patients come to me after previous treatments have failed, whether because medications did not work or because side effects were intolerable. If you have tried multiple medications without meaningful improvement, you may require a different approach.

Treatment with me begins with a careful diagnostic reassessment. Getting the full clinical picture right is frequently what changes the trajectory of treatment, and it requires considerably more time and attention than is often afforded patients. A reassessment can lead to a new diagnosis, or to identification of an underlying medical condition.

Depending on what we identify, treatment options extend well beyond trying another antidepressant, and may include switching to a novel class of medication, using a range of augmenting agents, or a specialized form of psychotherapy. I can also help determine the appropriateness of more intensive interventions such as ketamine or ECT. Some cases respond best to entirely distinct approaches, whether that means identifying medical contributions to symptoms or attending to sleep, nutrition, exercise, and other factors that contribute to depression.