Treatment-Resistant Depression (TRD)

TRD is typically defined as a failure to respond to at least two adequate trials of different antidepressant classes. At this stage, neurotechnological and alternative psychiatric interventions are considered.

Primary Interventions

• TMS: Considered the first-line neurotech intervention due to its high insurance coverage and strong safety profile.
• Ketamine / Spravato: Used for rapid symptom relief, especially when suicidality is present.

Frequently Asked Questions

• What is the standard definition of TRD? Typically, failure of 2 or more distinct antidepressant medications of adequate dose and duration.
• Will insurance cover treatments? Yes, for TRD, most commercial insurers will cover TMS, and many cover Spravato with prior authorization.

Common Mistakes

A common mistake is stopping a medication trial too early, which does not count as a "failed trial" for insurance authorization purposes.