- 21297 Foothill Blvd, Ste 203 Hayward, CA 94541 (by appointment only)
- (415) 636-9700
- hello@exxceedwellness.com
If you are reading this, something you tried for depression has stopped working, or never worked well enough. That is a common place to be and it is a known one: in the largest study of its kind, roughly a third of people had not reached remission after four successive medication steps, and the odds of remission fell with each step (Rush et al., 2006). The point of this page is to lay out what comes next in the order the decisions actually arrive, and to send you to the right detailed page for each one.
Where are you right now?
Two different situations hide inside that sentence. A medication that helped for months and then faded is one thing; a medication that never did much at an adequate dose for an adequate time is another, and the next step is different for each. Before anything else, it is worth confirming the trial was real: the right dose, taken long enough, without a gap. Many “failed” antidepressants were never given a fair run.
Treatment-resistant depression usually means depression that has not improved after two or more adequate antidepressant trials. The label matters less than what it unlocks: it is the threshold at which TMS and Spravato become options, and the threshold most insurers use to authorize them. A proper evaluation checks the history behind it, because the history is what the authorization is built on.
Both are approved for depression that has not responded to standard antidepressants. The choice usually comes down to how fast you need relief, what your week can hold, whether you can get a ride home, and what your plan will authorize, far more than to which treatment is stronger. We offer both in the same Hayward clinic, which means the decision can be made on your history rather than on which machine a given office happens to own.
Not responding to one does not predict failure with the other, and switching is a routine next step. Before switching, though, it is worth asking whether the course was complete. Stopping TMS at week two, or judging Spravato on the first few doses, is one of the most common reasons a treatment is written off before it had a chance.
Relapse is the central problem of treatment-resistant depression, and it has its own playbook. For TMS that often means a second course or maintenance sessions; a meaningful share of people who relapse after a first course respond to another (Dunner et al., 2014). For Spravato it usually means looking at the maintenance interval. Either way, the earlier the slip is caught, the smaller the correction.
New patients are usually seen within a week. The first visit is an evaluation, by telehealth anywhere in California or in person in Hayward, that goes through what you have tried, what each treatment did or did not do, and which of the options above fits. TMS and Spravato are delivered in person at the Hayward clinic.
Book a consultation or call (415) 636-9700.
This page is educational information and is not medical advice or a treatment recommendation for any individual. Reviewed by Nefretiri Abat, J.D., PMHNP-BC. If you are having thoughts of harming yourself, call or text 988 or go to your nearest emergency department.
