“Nothing has worked” is a starting point, not a conclusion.
An inadequate response to previous treatment should prompt a careful reassessment — of the diagnosis, of what was actually tried, of contributing factors, and of the options that have not been considered yet.
What treatment-resistant depression means
Depression is generally described as treatment-resistant when it has not improved adequately despite two or more antidepressant treatments given at an appropriate dose and for an adequate length of time. The precise criteria vary between clinicians and studies — what matters more is the practical situation: real treatment has been tried, and you are still unwell.
It is a common situation, not a rare one
A substantial share of people with depression do not respond adequately to the first or second treatment they try. That is a well-recognised clinical reality with an established set of next steps — not evidence that you are beyond help or that you did something wrong.
Four reasons standard treatment falls short
The diagnosis was incomplete
Bipolar spectrum illness, ADHD, trauma, anxiety and medical conditions can all sit underneath a depression diagnosis and change what will work.
Dose or duration
A medication given below an effective dose, or stopped before it had time to work, can look like a failed treatment when it was never really a trial.
Individual variation
People metabolise and respond to medication differently. Two people with the same diagnosis can need very different treatments.
Untreated contributing factors
Sleep disorders, thyroid problems, chronic pain, substance use and ongoing stressors can hold depression in place despite otherwise reasonable treatment.
A careful, individualized reassessment
As the physician who restarted and directed hospital ECT and TMS services from 2017, and the first Director of the Treatment Resistant Mood Clinic at Hope Tower, Dr. Abbas takes a systematic approach: reassessing the diagnosis, reviewing exactly what has been tried and at what dose, identifying contributing factors, and evaluating whether an advanced option such as TMS is appropriate.
What might be considered
- A fresh, comprehensive evaluation rather than a repeat of the same plan
- A structured review of every previous treatment, dose and duration
- Medication adjustments, including combinations and augmentation strategies
- Therapeutic and supportive interventions alongside medication
- Evaluation for TMS therapy where appropriate
The single most useful thing
A written list of every medication you have tried, the highest dose you reached, roughly how long you stayed on it, and why it stopped. Most people underestimate how much this changes the conversation — it turns a vague history into a map of what has genuinely been ruled out.
What people ask at this stage
Yes. A long list narrows the field rather than closing it, and it often reveals patterns — doses that were never reached, trials that were too short, or a diagnosis that does not quite fit.
It is one of the first things to check. Reassessment of the diagnosis is a standard part of evaluating depression that has not responded, not an accusation that anyone made a mistake.
No. TMS is one evidence-based option among several, and which ones are appropriate depends on your history. The point of the reassessment is to work out which are worth trying and in what order.
Not automatically. Changes are made deliberately and usually gradually, and stopping is a decision to make together rather than on your own.
It depends on what the reassessment finds. What you should get quickly is clarity about what is being recommended and why — the timeline follows from that.
You may also want to explore
Is TMS Right for Me?
A short self-assessment to bring a sharper question to your visit.
When traditional treatment has not been enough, there may still be options.
Bring your history. It is more useful than you think.