Psychiatry

Treatment-Resistant Depression Program

Image of doctor and female patient

Depression is the #1 cause of disability across the world, and approximately 10.4 percent of U.S. adults experience it in any given year. Occasionally, people experience depression that has not responded to typical therapies, such as talk therapy or medication. Studies show that more than one in three patients with depression fail to respond to two or more antidepressant trials—in other words, they have treatment-resistant depression (TRD).

At Mount Sinai, we focus on safe, innovative approaches to mental health care. We have a specialized approach if you have not responded to typical depression treatments, and the first step is a thorough evaluation.

How We Evaluate for Treatment-Resistant Depression

Because treatment-resistant depression is complex and can stem from a variety of causes, we need to start with a careful evaluation to gather as much information as possible. To create the best plan for you, we take a deep look at your past and current symptoms and previous treatments. Then, we use questionnaires to assess your current state of mind. If needed, we also use lab tests, genetic testing, and brain imaging. Once we have gathered as much information as possible, we will consult with you about your next steps in the process.

At the Depression and Anxiety Center we work with the Center for Neuromodulation, and experts across psychiatry, neuroscience, and neurology, to ensure we provide you with the best and most effective plan for treatment.

Our Treatment Options

The below options may be part of our recommended plan for depression in patients who have not responded to conventional methods.

  • Intensive medication management, therapy, and more: We use a range of evidence-based options with an emphasis on personalized care; these can include medications, individual cognitive behavioral therapy, intensive outpatient therapy, and group therapy
  • Esketamine nasal spray: Esketamine is delivered via nasal spray and was approved by the FDA in 2019 for treating TRD in adults in combination with an oral antidepressant. We are the first major academic medical institution in New York City to offer esketamine (SPRAVATO™ CIII nasal spray)* for TRD.
  • Transcranial Magnetic Stimulation: When you receive TMS treatment, you sit in a comfortable chair. You remain awake and alert while one of our psychiatrists places a TMS coil over your head. This coil generates a pulsating magnetic field that improves the communication among certain areas of the brain. These pulses are not painful and have few side effects.
  • Electroconvulsive therapy (ECT): ECT uses an electrical current in the brain while the patient is under general anesthesia. Doctors believe that this may help the brain "rewire" itself, which helps relieve symptoms. ECT is a safe, effective, rapid-acting intervention used to treat severe acute disorders unresponsive to other treatment modalities. For patients who are suicidal, can’t take antidepressants, or have not responded to antidepressants, ECT is the standard-of-care treatment.
  • Vagus Nerve Stimulation (VNS): VNS can be used to treat major depression that is not well controlled by medication or psychotherapy or electroconvulsive therapy. “Studies suggest that at the three-year mark approximately 40 to 50 percent of patients who undergo this procedure for depression report a significant reduction of symptoms,” says Brian Kopell, MD, Director of the Center for Neuromodulation.
  • Deep brain stimulation (DBS): Performed by neurosurgeons at the Center for Neuromodulation, DBS involves pinpointing (via brain scans) the exact spot in the brain that is causing the depressive symptoms. A neurosurgeon implants two electrodes into that area, which connects to a neurostimulator. The neurostimulator is implanted just under your skin, near the collarbone—like a pacemaker. This enables us to send electrical currents to your brain to ease your symptoms. Once the device is placed, we program the location, amplitude, duration, and frequency of the electrical pulse for the best result. In collaboration, the Nash Family Center for Advanced Circuit Therapeutics develops bold, new approaches for the treatments, looking beyond pharmacological therapies to focus on understanding and correcting the circuit-based mechanisms of major depression.

To schedule an evaluation, please reach out to dac@mssm.edu or 212-241-6539.

*Mount Sinai was involved in the research that led to the development of this new treatment method for treatment-resistant depression and receives financial remuneration from the manufacturer of SPRAVATO. Mount Sinai's Dean is a co-inventor of patents related to this new treatment method and as such receives remuneration through Mount Sinai from the manufacturer. For more information about these financial interests and Mount Sinai's leadership role in SPRAVATO, please visit bit.ly/esketamine-development.