Trying another medication can take effort, especially when previous changes brought little relief or difficult side effects. You may have noticed some improvement while still struggling to get through the day. You may wonder what remains worth trying.
At HavenNexus Advanced Psychiatry & TMS, we offer treatment-resistant depression care in Palm Coast, FL, including evaluation for TMS, IV ketamine, and SPRAVATO®. We begin by understanding what you have already experienced, so the next conversation builds on your history.
What Is Treatment-Resistant Depression?
Treatment-resistant depression, or TRD, generally describes major depressive disorder that has not improved sufficiently after at least two adequate antidepressant trials. An adequate trial involves an appropriate dose, enough time to assess response, and taking the medication as prescribed. Trying two medications does not, by itself, establish TRD.
The details matter. A medication stopped early because of side effects tells a different story from one taken consistently without enough benefit. Partial improvement also deserves attention: feeling somewhat better may still leave substantial difficulties with sleep, concentration, motivation, or relationships.
There is no single explanation for every unsuccessful treatment. Medication factors, other mental health conditions, physical health, sleep, and substance use may affect the picture. Treatment resistance does not mean you are beyond help. It means your symptoms and previous care deserve a closer look.
How HavenNexus Treats Treatment-Resistant Depression
We review your symptoms, current medications, health history, previous treatments, and goals. We want to hear what changed, what remained difficult, and what made a treatment hard to continue.
That information helps us discuss whether TMS, IV ketamine, or SPRAVATO® fits your needs. We also consider medication management within your broader care. If part of your existing plan has helped, that benefit matters when deciding what to continue or adjust.
Schedule a Treatment-Resistant Depression EvaluationTMS Therapy for Treatment-Resistant Depression
TMS therapy may be an option when antidepressants have not helped enough or have been difficult to tolerate. It uses magnetic pulses to stimulate brain areas involved in mood regulation. TMS devices have FDA clearance for treatment-resistant depression; eligibility depends on the device, treatment protocol, and individual evaluation.
During treatment, you sit in a chair while a coil is positioned near your scalp. You remain awake without anesthesia. Possible side effects include scalp discomfort and headache; seizures are a rare risk.
TMS involves repeated office visits. We explain the recommended schedule so you can consider how treatment would fit around work, family, and other responsibilities.
IV Ketamine Therapy for Treatment-Resistant Depression
We may consider IV ketamine therapy for selected patients whose depression has not responded sufficiently to antidepressants. Ketamine’s psychiatric use is off-label, meaning the FDA has not approved it for depression.
Our care involves clinically supervised, in-office infusions. Ketamine carries risks, including sedation, dissociation, increased blood pressure, breathing problems, and abuse or misuse. We discuss potential benefits, risks, and limitations in relation to your history before recommending treatment.
You do not need to arrive convinced that ketamine is the answer. We explain why it might be considered and how preparation, infusions, and follow-up would fit into your psychiatric care.
SPRAVATO® (Esketamine) for Treatment-Resistant Depression
SPRAVATO® is an esketamine nasal spray, distinct from IV ketamine. It is FDA-approved for treatment-resistant depression in adults, either alone or with an oral antidepressant.
Patients self-administer SPRAVATO® under clinical supervision in a REMS-certified healthcare setting. Each visit includes at least two hours of monitoring. Risks include sedation, dissociation, breathing problems, increased blood pressure, and abuse or misuse.
You need someone to drive you home and must not drive or operate machinery until the next day after restful sleep. We discuss these requirements alongside eligibility so you can plan for the time and support each visit requires.
What to Expect During Treatment-Resistant Depression Care at HavenNexus
Bring your questions, medication list, and any previous treatment records you have. If you cannot remember every dose or date, you can still begin the conversation.
We explain recommended options, visit requirements, and follow-up. In selected cases, our clinicians may consider TMS alongside SPRAVATO® or IV ketamine after reviewing treatment history and relevant risks.
We offer in-office and telehealth psychiatric care; the three advanced treatments require office visits. As care continues, we review symptom changes, side effects, and daily functioning to help determine whether the plan should continue or change.
Insurance and Payment for Treatment-Resistant Depression Care
TMS and SPRAVATO® may be covered when insurance and clinical eligibility requirements are met. IV ketamine is self-pay. Accepting an insurance plan does not guarantee coverage for every treatment.
Our team can review benefits and explain authorization and payment requirements. Visit Insurance and Fees for accepted plans and self-pay information.
Schedule a Treatment-Resistant Depression Consultation in Palm Coast, FL
Previous disappointment can make another appointment feel difficult. You can bring that uncertainty with you. We will review your experience and help you understand the options worth considering.
Frequently Asked Questions About Treatment-Resistant Depression
Does trying several antidepressants automatically mean I have TRD?
No. The dose, duration, consistency of use, and response to each trial matter. An evaluation helps determine whether TRD describes your history.
What options can I discuss when antidepressants have not helped?
We can review whether medication adjustments or evaluation for TMS, IV ketamine, or SPRAVATO® is appropriate. You do not need to choose a treatment before your appointment.
How are IV ketamine and SPRAVATO® different?
IV ketamine is delivered by infusion and used off-label for depression. SPRAVATO® is an FDA-approved esketamine nasal spray for specific adult depression indications, with required supervised administration and monitoring.
Will I need to stop my current antidepressant?
Not necessarily. We review your medications when planning care. Do not stop or change a prescribed medication without guidance from your provider.
How will we assess whether treatment is helping?
Your account of what is becoming easier, or what remains difficult, matters alongside changes in symptoms and side effects. Progress may include changes in everyday responsibilities, relationships, or activities you value.
Treatment-Resistant Depression Crisis Support
If you are in immediate danger or unable to stay safe, call 911 or go to the nearest emergency department. For crisis support, call or text 988, the 988 Suicide & Crisis Lifeline. Routine appointments do not replace emergency care.
Scientific Resources
Medical Disclaimer
This page provides educational information and does not replace individualized medical evaluation, diagnosis, or treatment. Treatment eligibility, recommendations, and results vary by patient.