If you've tried medication after medication and still feel stuck, the answer is rarely "try harder." It's usually that something hasn't been found yet. My job is to find it — and then build a plan that finally works for you.
"Depression" isn't a single condition — it's a family of disorders that can look and behave very differently from one person to the next. Understanding which type you're living with is the first step toward treating it well, because the right treatment depends entirely on the right diagnosis.
Persistent low mood, loss of interest, fatigue, and changes in sleep or appetite lasting two weeks or more.
A lower-grade but long-lasting depression that can quietly persist for years.
Depressive episodes that alternate with periods of elevated or irritable mood — and require a very different treatment approach.
Depression tied to seasonal changes, most often during the darker winter months.
Depression occurring during pregnancy or after childbirth.
Low mood driven by medical conditions, medications, or substance use that must be identified and addressed.
Treatment-resistant depression (TRD) generally describes depression that has not responded adequately to at least two appropriate antidepressant treatments — each given at the right dose for a long enough time. In other words, you've genuinely tried, and you're still not well.
Here's what I want you to know: "treatment-resistant" does not mean untreatable. Very often, it means the underlying picture is more complicated than it first appeared — and that complexity simply hasn't been fully explored. That's exactly where my work begins.
I don't believe in adding one more pill and hoping for the best. I believe in understanding the whole person — methodically, patiently, and thoroughly — until we get to the real reason your depression hasn't been treated the right way. Here is the path we'll walk together.
We start by getting to the bottom of why your depression isn't responding. That means a deep review of your past medical history, past surgical history, and family history — and just as importantly, the social factors and current stressors in your life that may be quietly working against your medications.
I carefully go through every medication you've tried — what was used, at what dose, for how long, and how you responded. So often, the story isn't that nothing works; it's that the right treatment was never given a fair trial.
Depression can be the surface presentation of another, undiagnosed illness — whether medical or psychiatric. We work to identify and rule out (or properly treat) those underlying conditions. If depression persists once they've been excluded or successfully addressed, we keep going.
If depression continues, the next step may include psychological testing or other specialized forms of evaluation to uncover anything earlier assessments may have missed.
I use genetic testing to understand how your body is likely to respond to specific medications. Together, you and I then use those results to build the best possible medication plan — one designed around your biology and your goals, not trial and error.
Sometimes, even when every option has been accounted for, medication alone isn't sufficient. That's when our interventional psychiatry tools come into play — advanced treatments that work differently from pills and offer real hope for difficult cases.
For depression that hasn't responded to medication, these evidence-based interventions can change the picture.
Transcranial magnetic stimulation uses gentle magnetic pulses to stimulate the areas of the brain involved in mood regulation. It's non-invasive, medication-free, and has an excellent rate of response for treatment-resistant depression.
Spravato is a nasal-spray treatment given under medical supervision, specifically approved for treatment-resistant depression. For many patients who haven't responded to standard antidepressants, it offers a new and meaningful path to relief.
If your depression has resisted treatment, I'd welcome the chance to take a closer look — thoroughly, privately, and without rushing. We will leave no stone unturned.
Request a consultationSpravato® is a registered trademark of its respective owner. This page is for general educational purposes and is not medical advice. Individual results are not guaranteed and may vary from person to person. Please consult a qualified clinician about your specific situation.