Written by Kat Kreiger, PA-C, and clinically reviewed by Kartiki Churi, MD, Chief Medical Officer, Axis Integrated Mental Health, Denver Tech Center.
Antidepressants fail because of two main reasons: a) trial may have been too short, b) an underlying condition may be undiagnosed/misdiagnosed. Also, lack of sleep, hormonal imbalance, or untreated trauma can lead to antidepressant failure.
When this happens, you need psychiatric care that goes beyond meds. Advanced treatment options like Deep TMS and Spravato work differently from a daily antidepressant. Spravato is an FDA-approved nasal spray while Deep TMS uses magnetic stimulations to activate the parts of the brain that control mood.
You’ll have more questions after reading this. Good. Book a free consult and ask every one of them. It’s free, and there’s no pressure.
Why do antidepressants stop working, or never work at all?
Here are the most common reasons I see:
- Side effects won. Weight gain, sleep problems, or emotional blunting can make people stop early.
- Something is working against medicine. Daily alcohol or cannabis use, less than seven hours of sleep, hormone shifts, and dark winter months can all blunt a good medication.
- Your brain needs a different approach. Some depression simply doesn’t respond to pills that target serotonin.
If you feel worse in winter, our post on still feeling depressed on antidepressants goes deeper.
How do I know if I have treatment-resistant depression?
You may have treatment-resistant depression if two or more antidepressants, taken at a full dose for a full trial, haven’t brought real relief. It’s more common than most people think.
A 2025 study in the British Journal of Psychiatry looked at the health records of 5,136 adults with major depression. Nearly half (47.9%) met the definition of treatment-resistant depression, and more than a third of that group had tried four or more antidepressants without relief. Patients described it as “trial and error.”
If that sounds like you, you aren’t broken. You’ve just reached the point where a different kind of treatment makes sense.
Is it medication, or is it diagnosis?
This is the question that sets our approach apart, and it’s the one I wish more people asked first.
Sometimes the antidepressant isn’t failing. It’s treating the wrong thing. At Axis, our Chief Medical Officer, Dr. Kartiki Churi, calls this the Diagnosis Gap: depression that gets missed, mislabeled, or only half treated.
In our clinic, the most common hidden drivers are:
- Undiagnosed ADHD
- Bipolar disorder that shows up as depression first
- PTSD or past trauma
- Substance use that keeps the brain from healing
- Hormone changes, like perimenopause
These same factors can also make advanced treatments work less well. That’s why a careful diagnosis comes before any new treatment. Fixing the diagnosis can make the next medication, or the next treatment, actually work.
What is antidepressant management, and what should it include?
Antidepressant management is ongoing care where a psychiatric provider picks, adjusts, combines, or tapers your medications based on how you respond. Good management is active. It doesn’t mean refilling the same dose for two years.
Strong antidepressant management should include:
- A review of every medication you’ve tried, with doses and dates
- A clear plan for how long to wait before changing course
- Checks for side effects like numbness, fatigue, or weight change
- A diagnosis review when progress stalls
- Help to safely reduce medications that aren’t helping
- Access to next-step treatments when pills aren’t enough
How can Spravato help when antidepressants fail?
Spravato is an FDA-approved nasal spray made from esketamine. It works on glutamate, a different brain system than most antidepressants, and some people feel better within days instead of weeks. You take it in the clinic and rest under supervision for about two hours.
In January 2025, the FDA approved Spravato as the first stand-alone treatment for adults with major depression who haven’t responded to at least two oral antidepressants. That means it can be used with or without a daily pill.
Spravato is usually a fit if you’ve had at least two antidepressant trials. It’s not a fit if you have a history of schizophrenia or active substance use. Most commercial plans and Colorado Medicaid cover it. You can estimate your Spravato cost before you book.
How can Deep TMS help when medication doesn’t?
Deep TMS is a non-drug treatment that uses a magnetic H-coil helmet to activate mood centers deep in the brain. Sessions last about 20 minutes. There’s no anesthesia, so you can drive yourself back to work.
In a large real-world study of Deep TMS for depression, 82% of patients responded and 65% reached remission, meaning their symptoms were mostly gone.
You’ll get the most from Deep TMS if you:
- Sleep seven to eight hours a night
- Finish the full course, even after you start to feel better
- Avoid alcohol and recreational drugs
- Protect your schedule so you don’t miss sessions
Most commercial plans cover Deep TMS. Colorado Medicaid does not. Our TMS cost calculator shows what you might pay.
How do I choose between Spravato and Deep TMS?
You don’t have to choose alone. Your psychiatric provider will help you weigh your history, schedule, and insurance. Here’s a simple way to compare:
| Feature | Spravato | Deep TMS |
|---|---|---|
| What it is | Nasal spray (esketamine) | Magnetic brain stimulation |
| Time per visit | About 2 hours with monitoring | About 20 minutes |
| Post Treatment Care | No driving for 24-hours | Can drive |
| Medication? | Yes | No |
| Colorado Medicaid | Covered | Not covered |
If one doesn’t work, the other is often the next step. For example, when Spravato falls short, we often move to Deep TMS.
What should I look for in a psychiatrist before I book an intake?
Look for a psychiatrist or psychiatric nurse practitioner who reviews your full medication history, rechecks your diagnosis, and offers treatment beyond pills in the same clinic. Short wait times and help with insurance matter too.
Before you book, ask these questions:
- Will you review every medication I’ve tried, not just the latest one?
- How will you check whether ADHD, bipolar disorder, or trauma is part of the picture?
- Do you offer Spravato and Deep TMS here, or will I need a new referral?
- How soon can I be seen?
- Will your team handle prior authorization with my insurance?
If a clinic can’t answer these clearly, keep looking.
What should I bring to my first appointment?
Bring a simple timeline of every antidepressant you’ve taken. It’s the single most useful thing you can hand a new provider, and it can save weeks of guessing. Copy this template into your phone:
| Medication | Highest dose | How long | What helped | What didn’t (side effects) | Why I stopped |
|---|---|---|---|---|---|
| Example: sertraline | 100 mg | 4 months | Less anxiety | Felt numb | Provider switched it |
Add your sleep habits, alcohol or cannabis use, and any family history of bipolar disorder. If your memory is fuzzy, your pharmacy can print your fill history.
Where can I find depression treatment in DTC, Denver, Boulder, and Westminster?
You can find depression treatment in DTC at Axis Integrated Mental Health, 6950 E Belleview Ave, Suite 300, near I-25 and the Belleview light rail station. Axis also offers depression treatment in Denver at our Aurora clinic, depression treatment in Boulder at our Louisville clinic, depression treatment in Westminster, and telehealth statewide.
Getting care matters here. In the 2025 Colorado Health Access Survey, 20.5% of Coloradans reported eight or more days of poor mental health in the past month. The same survey found 14.4% of women and 10.0% of men couldn’t get the mental health care they needed.
Our DTC clinic is our Deep TMS center of excellence. It’s built for busy professionals in Greenwood Village, Centennial, Englewood, and Littleton who need care that fits around the workday.
Axis has been named ColoradoBiz Top Startup of the Year and a Best of Mile High winner three years running. But the best proof is how you feel a few weeks from now.
Not ready to book? Schedule a free consult with a co-founder and ask anything. Ready now? Book online, call or text 720-400-7025, or check your coverage.
Frequently asked questions
Jump to: Medication questions | Advanced treatment questions | Getting care questions
Medication questions
How do I know if my antidepressant stopped working or never worked?
If you felt better for months and symptoms slowly returned, it may have stopped working. If you never felt a clear lift after six to eight weeks at a full dose, it likely never worked. Both are reasons to see a provider about antidepressant management, not to quit on your own.
Can I stay on my antidepressant during Spravato or Deep TMS?
Often, yes. Spravato can be used with or without a daily antidepressant, and many people stay on their medication during Deep TMS. Your provider will decide what’s safest for you. Learn more on our alternative depression treatments page.
Advanced treatment questions
What happens if Spravato doesn’t work for me?
Your provider will first check for hidden factors like ADHD, bipolar disorder, PTSD, or substance use. If those are ruled out, Deep TMS is usually the next step. See how Deep TMS works.
Can I get Spravato or Deep TMS covered by Colorado Medicaid?
Colorado Medicaid covers Spravato but does not cover Deep TMS. Most commercial plans cover both after prior authorization. Check your coverage for free before your visit.
Getting care questions
How do I switch to a new psychiatrist in Denver without running out of medication?
Keep taking your current medication and stay with your current prescriber until your first new visit. Bring your medication timeline and pharmacy history. At Axis, new patients are usually seen within seven days. Find a provider near you.
If you’re having thoughts of suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline, available 24/7. If you’re in immediate danger, call 911.
