If depression has continued despite treatment, it can be hard to know what to try next. We review the medications and therapies you have tried, talk through what helped and what did not, and discuss appropriate next steps during an in-person evaluation in West Hartford.
Treatment starts with understanding your experience and choosing a plan together.
Depending on your history, options may include adjusting or changing medication, adding another treatment, or revisiting the therapy approach. A new plan should include clear reasons and a time to review whether it is helping.
Spravato is esketamine nasal spray, an FDA-approved option for treatment-resistant depression in adults. Esketamine is one of two mirror-image forms of ketamine. For adult TRD, Spravato may be used alone or with an oral antidepressant. It is administered under supervision in a certified healthcare setting with monitoring for at least two hours.
Some people may benefit from treatments such as transcranial magnetic stimulation, or TMS, or electroconvulsive therapy, or ECT. These are different treatments with their own assessments and care settings. We can discuss whether an outside referral is appropriate; they are not procedures provided at this office.
A conversation about what has been happening and what you would like to change.
A list of past antidepressants is especially useful. Include doses, approximate dates, side effects and any benefit you noticed, if you remember. Bring information about previous therapy and other medical care. Missing records do not need to stop you from reaching out. We review the history together and decide what further information would help.
We explain the options, answer your questions and discuss follow-up based on your needs. You can ask about benefits, possible risks and other approaches before making a decision.
All visits are in person at 10 Princeton St, Ste N, West Hartford, CT 06110. We do not offer telehealth.
An evaluation considers the full picture, including other concerns that may overlap.
Treatment-resistant depression commonly describes depression that has not improved enough after at least two adequate antidepressant trials. An adequate trial considers the medication, dose, duration and whether it could be taken consistently. An evaluation is needed to understand whether that description fits your history.
Persistent symptoms can have several explanations. We review the diagnosis, side effects, other health conditions, sleep, substance use and access to treatment. This is a chance to understand what happened and what to consider next, without blaming you for treatments that did not help.
These examples can help you describe what you are experiencing. They are not a self-diagnosis.
If symptoms are affecting daily life, relationships or your ability to look after yourself, it is reasonable to ask for support. You do not need to be certain about a diagnosis before contacting us.
Notes about when symptoms happen, what makes them better or worse, and what you have already tried can help start the conversation.
Request an appointmentPractical answers to help you decide on your next step.
No. A lack of response to earlier treatment does not mean that all options have been exhausted. The next step depends on a careful review of your symptoms and treatment history.
No. An evaluation considers benefits, risks, medical history, preferences and other options. Spravato is one possible treatment, not an automatic next step.
No. Spravato is a specific esketamine nasal spray with FDA-approved indications and a restricted safety program. Intravenous ketamine is a different formulation and route of administration.
Our Spravato service page explains supervised visits, monitoring, transportation and the treatment schedule. Those details apply to Spravato rather than every treatment for TRD.
All appointments are in person at our West Hartford office for adults 18 and over. We do not offer telehealth.
You can request an appointment directly. Insurance requirements vary, so the office can help check whether your plan requires a referral or authorization and discuss expected costs. Contact us about coverage or self-pay before scheduling.
Explore a service or concern that may be part of your care.
Sources: NIMH: Depression, Spravato prescribing information. This page provides general information. Your clinician can help determine what applies to you.
Contact our West Hartford office to request an in-person visit. You can tell us what has been difficult and ask about the next step.
