Treatment-Resistant Depression

Treatment-resistant depression (TRD) is a term used when depression has not improved sufficiently despite adequate treatment — typically after trying two or more antidepressants at an adequate dose and duration. It does not mean depression cannot be treated; it means it is worth reviewing the diagnosis, the treatment so far, and the options that haven't yet been explored.

A specialist psychiatric review can clarify whether the diagnosis and treatment have been optimised, identify contributing factors, and discuss further evidence-based options.

Several factors can contribute to depression not responding as hoped, including the dose or duration of previous treatments, co-occurring conditions (such as anxiety, ADHD, or physical health problems), ongoing stressors, and individual differences in how people respond to medication. A careful review aims to identify which of these may be relevant.

A specialist assessment for treatment-resistant depression involves:

• A thorough review of your history, symptoms, and the treatments you have tried, including doses and how long each was used.
• Reconsidering the diagnosis and screening for co-occurring conditions that may be affecting recovery.
• A shared discussion of options, so you understand the potential next steps and what each involves.

Assessments are conducted via telehealth, and a valid GP referral is required.

Depending on the assessment, options that may be discussed include:

• Optimising current treatment: adjusting medication, dose, or duration, or considering augmentation strategies.
• Psychotherapy: ensuring evidence-based psychological therapy is part of the plan, coordinated with your GP.
• Transcranial Magnetic Stimulation (TMS): a non-invasive treatment delivered at specialist treatment centres. Mindscape assesses suitability and coordinates referral.
• Esketamine therapy: an option for some patients with TRD, administered under medical supervision at certified treatment centres. Mindscape assesses suitability and coordinates referral.
• Hospital-based treatments: where appropriate, referral pathways to treatments such as ECT can be discussed.

Suitability for any treatment is determined on an individual basis. TMS and Esketamine are delivered at specialist centres rather than at Mindscape; our role is specialist assessment, referral, and ongoing psychiatric oversight.

Specialist assessment for treatment-resistant depression at Mindscape Psychiatry is provided by Dr Ashutosh Dessai, Consultant Psychiatrist and Professor of Psychiatry. Dr Dessai reviews your history and treatment to date, discusses suitability for advanced options including TMS and Esketamine, and — where appropriate — coordinates referral to specialist treatment centres while maintaining psychiatric oversight of your care.

• Specialist review of complex or persistent depression.
• Clear, shared decision-making about next steps.
• Coordinated care with your GP and treatment centres, via secure telehealth.

A valid GP referral is required. Speak with your GP about a referral to Mindscape Psychiatry.