Southern Illinois Associates LLC

Treatment Resistant Depression (TRD)

If you’ve been treated for depression but your symptoms haven’t improved, you may have treatment-resistant depression. Taking an antidepressant or going to psychological counseling (psychotherapy) eases depression symptoms for most people. But with treatment-resistant depression, standard treatments aren’t enough. They may not help much at all, or your symptoms may improve, only to keep coming back.

“We treat treatment resistant depression”

Risk Factor for TRD

Duration of the episode

The longer the episode of depression, the greater the atrophy in specific brain regions (eg, hippocampus); the cognitive and behavioral changes that take place during long episodes make a return to previous well-being difficult

Severity of the episode

Both ends of the depression spectrum (most severe, mildest) are hypothesized to increase the risk of poor response-severe depression is associated with biological unbalances; mild depression, with lower drug versus placebo response

Co-morbid Disorders

Comorbid disorders like anxious symptoms and full anxiety disorders (especially generalized anxiety disorder) were found to be predictors of lower rates of response and remission; personality disorders, especially avoidant and borderline, are negative prognostic factors

Biological factors

Biological factors have also been studied as possible predictors of TRD. Genetic variants within the serotonin transporter-serotonin receptors and genes involved in neurodevelopment-have been found to modulate the risk of TRD.

Combination of antidepressants

In spite of the large number of antidepressants available at the present time, they are far from ideal and all show a similar slow, and frequently, incomplete response. Thus, the need for new and better compounds is as urgent and compelling as ever. While waiting for the panacea of future antidepressants, clinicians have developed a variety of associations of several antidepressants or an antidepressant with a second different agent.

Augmentation with another drug

A combination of 2 antidepressants or augmentation with another drug, such as lithium, a thyroid hormone, or an atypical antipsychotic, can be tried. The most robust evidence is augmentation of conventional antidepressant therapy with atypical antipsychotics. Switching to another antidepressant may also help. However, there is no clear evidence to guide the choice between augmentation and switching

Psychological counseling

Psychological counseling (psychotherapy) by a psychiatrist, psychologist or other mental health professional can be very effective. For many people, psychotherapy combined with medication works best. It can help identify underlying concerns that may be adding to your depression. For example, psychotherapy can help you:

Find better ways to cope with life’s challenges

Deal with past emotional trauma

Manage relationships in a healthier way

Learn how to reduce the effects of stress in your life

Address substance use issues

Treatment options

Transcranial magnetic stimulation (TMS)


TMS is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. TMS is typically used when other depression treatments haven’t been effective.

This treatment for depression involves delivering repetitive magnetic pulses, so it’s called repetitive TMS or rTMS.


Spravato is a prescription medicine, used along with an antidepressant taken by mouth, for treatment-resistant depression (TRD) in adults.

SPRAVATO® is a non-competitive N-methyl D-aspartate (NMDA) receptor antagonist
indicated, in conjunction with an oral antidepressant, for the treatment of:
• Treatment-resistant depression (TRD) in adults.  
• Depressive symptoms in adults with major depressive disorder (MDD) with
acute suicidal ideation or behavior.