Depression with anxiety — the two very often occur together
Telehealth follow-up — secure video visits across California
Which medications you tried, at what dose, and for how long. Many are stopped before they have had a fair trial
Depression that has not improved after two or more medication trials at an adequate dose and length is often called treatment-resistant depression. It is a starting point for a different approach, not a dead end.
Do not stop antidepressant medication on your own. Talk to your prescriber first.
People process medications differently. Part of that difference is genetic, and it can affect how a medication behaves in your body. Pharmacogenomic testing is usually a cheek swab sent to a lab. It can show how your body may process certain medications, and where side effects may be more likely.
What it cannot do is tell you which medication will work. It does not pick your treatment. It is one piece of information your psychiatrist considers alongside your symptoms, your history, and how you responded to treatment before.
TMS and SPRAVATO are not stronger antidepressants. They work differently, and they are considered for people whose depression has not responded to standard treatment. Whether either fits you is decided at an evaluation.
| TMS therapy | SPRAVATO (esketamine) | |
|---|---|---|
| What it is | Magnetic pulses to areas of the brain involved in mood | A nasal spray you use yourself, under supervision |
| FDA status | Cleared for major depressive disorder | Approved for adults with treatment-resistant depression, either with an oral antidepressant or on its own, and, with an oral antidepressant, for depressive symptoms in adults with MDD who have active suicidal thoughts or behaviour |
| Where it is given | In-office sessions | Only in a certified healthcare setting. It cannot be taken home. |
| What a visit looks like | You stay awake, no anesthesia, then go about your day | Monitored for at least two hours afterward, and no driving for the rest of the day |
| Typical course | A series of sessions over several weeks | Scheduled sessions, tapering over time |
| Key safety notes | Screening required. Scalp discomfort or headache is possible early on. | Carries a boxed warning covering sedation, dissociation, abuse and misuse, and suicidal thoughts and behaviors. Dispensed only through a restricted program. |
A full assessment, a diagnosis, and a plan you understand and agreed to.
Therapy, medication, or both. You know what to expect, how long to give it, and which side effects to report.
Visits are closer together at the start. Response and side effects are checked, and the plan is adjusted rather than left to run.
If you are improving, care continues and visits space out. If you are not improving enough, the next options are discussed, which may include pharmacogenomic testing, TMS, or SPRAVATO.
If you have any questions, concerns, or comments regarding Sal Psychiatry Services, please fill out the short contact form below. Contact us today to begin your journey of healing and transformation.
You do not have to work out whether you need therapy, medication, TMS, or SPRAVATO before you call. That is what the evaluation is for. Sal Psychiatry offers psychiatrist-led outpatient care at the Norwalk, CA office and by telehealth across California. Call (562) 280-7176 or book online. If you are in crisis, call or text 988 instead of waiting.