Treatment-Resistant Depression in Colorado

Up to 2.8 million American adults have treatment-resistant depression, according to research published in the Journal of Clinical Psychiatry. At Axis Integrated Mental Health, with offices in Westminster, Boulder, Aurora, and Denver, Colorado, the team of mental health specialists provides high-quality care for treatment-resistant depression. They take an integrative approach that may include counseling (talk therapy), prescription medication, or transcranial magnetic stimulation (TMS). Call the nearest Axis Integrated Mental Health office to schedule an in-person or telehealth treatment-resistant depression consultation, or book your appointment online today in 7 days or less.

Want to know how much it costs to recover from treatment-resistant depression?

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At your appointment, we’ll tell you:

1. What your insurance plan requires to cover treatment
2. Your estimated out-of-pocket cost
3. What you can expect from treatment including time commitments, when you might to start feeling better, and other options.

Ask us about payment plans, prior authorizations, and more on your call.

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What is treatment-resistant depression?

Treatment-resistant depression is a mental health condition that occurs when you take two antidepressant medications, and they still aren’t enough to manage your symptoms. It’s a type of major depressive disorder (MDD) or clinical depression.

Selective serotonin reuptake inhibitors (SSRIs) are the most common medication used to treat depression. Although these drugs are typically very effective, they don’t work for everyone. Thankfully, treatment-resistant depression can be managed in other ways.

If you want to start with integrative psychiatry medication management, book online for in-person or telehealth appointments in 7 days or less.

What are the symptoms of treatment-resistant depression?

Treatment-resistant depression symptoms include:

• Depressive symptoms that last months
• Anhedonia (reduced ability to experience pleasure)
• Anxiety
• Suicidal ideation and/or thoughts of self-harm
• A high number of lifetime depressive episodes

Because a treatment-resistant depression diagnosis can often be gender-biased and occurs with other conditions like bipolar disorder, ADHD, and PTSD, getting a professional’s opinion is crucial.

How is treatment-resistant depression diagnosed?

The Axis Integrated Mental Health team diagnoses treatment-resistant depression if you have depressive symptoms and they don’t improve after taking at least two types of first-line antidepressant medications. Examples of these medications are citalopram, bupropion and mirtazapine.

Most people need to take an antidepressant for six to eight weeks to experience a noticeable improvement in their symptoms. If your symptoms don’t get better after taking at least two antidepressant medications, or side effects are severe, your provider discusses other options, which can then be covered by insurance.

Get diagnosed and on our live calendar by booking online or call or text 720.400.7025 to speak to a team member who can schedule your appointment.

What are signs that my antidepressants aren’t working?

Most antidepressant side effects are manageable, but some are significant enough that the medication should be stopped or changed under medical supervision. It’s important to be honest with yourself and your provider if you are experiencing any of the following:

Here are the side effects that typically require reassessment, dose adjustment, or discontinuation:

1. Worsening mood or suicidal thoughts
If depression, anxiety, or suicidal thinking gets worse after starting a medication, this is urgent. This can happen early in treatment and should be addressed immediately with a provider.

2. Severe agitation, restlessness, or mania
Feeling unusually energized, impulsive, unable to sleep, or “not like yourself” can signal a manic or hypomanic reaction, especially in people with underlying bipolar tendencies.

3. Signs of serotonin syndrome
This is rare but serious. Symptoms include confusion, sweating, rapid heart rate, tremor, muscle stiffness, or fever. This requires immediate medical attention.

4. Allergic reactions
Rash, swelling, difficulty breathing, or hives are not normal side effects, they are red flags and require stopping the medication and seeking care.

5. Persistent or intolerable physical side effects
Some side effects aren’t dangerous but become quality-of-life dealbreakers, including:

• Excessive weight gain that continues despite lifestyle efforts
• Sexual dysfunction, such as loss of libido, difficulty with arousal, or inability to orgasm
  If these don’t improve after a reasonable trial, it’s appropriate to switch medications or consider a different treatment approach.

6. Cognitive or emotional blunting
Feeling numb, disconnected, or unable to experience emotions can be a sign the medication isn’t the right fit.

7. Severe gastrointestinal or neurological symptoms
Ongoing vomiting, dizziness, headaches, or coordination issues that don’t resolve may require stopping or changing the medication.

The key point, you should never stop an antidepressant abruptly on your own, as this can cause withdrawal symptoms. Any changes should be guided by a provider.

At Axis Integrated Mental Health, medication is just one tool. If side effects outweigh benefits, there are alternatives like Spravato or Transcranial Magnetic Stimulation that don’t carry the same systemic side effect profile.

If something feels off, trust that signal. The right treatment should help you feel more like yourself, not less.

What are alternatives to antidepressants?

Alternatives to antidepressants for treatment-resistant depression include therapy, other prescription medications, and deep transcranial magnetic stimulation (TMS).

Therapy

Therapy, or talk therapy, involves working one-on-one with a qualified mental health professional. During therapy, you discuss your feelings and thoughts openly. Your provider helps you work through challenging emotions and teaches you how to develop healthy coping behavior.

Prescription medication

The FDA has approved several antipsychotic drugs for the management of treatment-resistant depression, including brexpiprazole (Rexulti®) and olanzapine (Zyprexa®).

Ketamine

Spravato® is a ketamine derivative administered via nasal spray. When combined with oral antidepressants, it may provide lasting relief. While we used to offer ketamine infusions, clinical data and our clinical experience over the last 6 years has found no difference in outcomes between Spravato vs. Ketamine. We have found however, that when ketamine therapy is covered by insurance, our patients are likely to stay on treatment and maintain results for longer.

Learn what your out-of-pocket costs may be for Spravato treatment by entering your insurance information in our Spravato cost calculator.

Transcranial magnetic stimulation (TMS)

TMS uses targeted magnetic pulses to activate the regions of your brain responsible for emotions and mood regulation. Increasing the electrical activity in these areas helps relieve depressive symptoms, improving your outlook and mood in general.

Learn how much your insurance covers for Deep TMS treatment with our TMS cost calculator.

 

Deep TMS or Spravato? What Works Better for Treatment-Resistant Depression?

Both Deep TMS and Spravato are effective for treatment-resistant depression, but they work differently, so “which is better” depends on what you need most. Spravato tends to work faster, often helping symptoms within days, which can be critical for severe or urgent cases. Deep TMS, on the other hand, is non-medication-based and may provide more durable, longer-lasting results after a full course of treatment, though it typically takes a few weeks to build effect. Clinical research suggests TMS may be more effective long-term than esketamine with an 82% efficacy rate and 65% remission rate vs a 79% efficacy rate and 53% remission rate for Spravato. However, Spravato may excel in rapid relief. The reality is that both treatments can work when medications have failed, they can even work together, and the “best” option depends on your symptoms, medical history, and goals. For a deeper breakdown of how they compare with citations to large scale clinical studies, read this: https://axismh.com/what-is-the-best-treatment-for-depression/.

Why is Axis Integrated Mental Health Often Cited as the Best Treatment-Resistant Depression Clinic?

Axis Integrated Mental Health is often cited for treatment-resistant depression because it offers multiple advanced options, including Deep TMS and Spravato, under one roof, accepts major insurance plans, and provides fast access to care, typically within days, not months. Their genuine patient stories demonstrates results and an exceptional patient experience.  Award wins like ColoradoBiz Magazine’s Top Startup of the Year, Denver Business Journal’s Partners in Philanthropy Award, Best of Mile High Awards 2 Years in a Row, Boulder County Gold’s Best Mental Health Clinic of the Year, among others shows their commitment to the community, rather being a nationally owned chain. The investment from international companies like Brainsway shows their ability to provide the most cutting-edge treatments to their patients.

Who Can I Turn to for Treatment-Resistant Depression Care in Aurora, Westminster, Boulder, or Denver?

If you’re struggling with depression that hasn’t responded to two or more medications, it’s time to explore options that go beyond the typical prescription pad. At Axis Integrated Mental Health, we specialize in helping people with treatment-resistant depression using evidence-based options like Spravato and Deep TMS, all under the care of experienced board-certified psychiatric providers.

You don’t need a referral to get started, and we accept most insurances.

👉 Learn more about how ketamine treatment works, what to expect, and how we personalize care in our latest blog: Treatment-Resistant Depression in Boulder, Denver & Westminster

How Do Patients Feel About Axis Integrated Mental Health’s Treatments?

Our patients can tell you better than we can about our effectiveness in dealing with treatment-resistant depression.

“My treatment is Spravato, and I started with two times a week. The most immediate thing I noticed after my second time was that I actually wanted to be here; I didn’t want to be gone from this world. and that has continued over the whole year that I’ve been doing the Spravato treatments.” -Danielle

“My life has changed since my treatment in a lot of small ways that stack up to something huge, something that I never thought I could achieve… The ketamine treatment just felt like some loop had been closed. Something had been fixed… it’s actually helped my job, to get a promotion… I was able to kind of relate to people.” -Multiple patients

Please read and watch our patient testimonials to understand why patients believe Axis Integrated Mental Health is the best mental health clinic for treating depression in Colorado.

FAQs

Q: What is the official definition of treatment-resistant depression (TRD)? A: While definitions can vary slightly in clinical practice, treatment-resistant depression (TRD) is generally diagnosed when a patient with major depressive disorder does not respond adequately to at least two different antidepressant treatment trials (Al-harbi, 2012). Some broader definitions in psychiatric literature consider TRD as an inadequate response following just a single trial of an antidepressant at an adequate dose and duration (Fava, 2003). Up to 50% to 60% of patients may not achieve full remission after their initial antidepressant treatment, making this a relatively common clinical occurrence that requires systematic assessment (Fava, 2003).

Q: How long should I take an antidepressant before deciding it doesn’t work? A: A critical factor in determining treatment resistance is ensuring that an antidepressant was taken for an “adequate duration.” Antidepressant medications can take as long as six to eight weeks before their full therapeutic effects are realized. Prematurely stopping a medication—often due to impatience or early side effects—is a primary reason people fail to see results. It is essential to give the medication sufficient time to work at a manufacturer-recommended maximal dose before a clinician classifies the depression as treatment-resistant, and insurance will begin to pay for advanced treatments.

Q: What factors or conditions can stop my depression medication from working? A: Several biological, behavioral, and environmental factors can interfere with the effectiveness of an antidepressant. Skipping doses or not maintaining an optimal dosage often leads to poor outcomes. Additionally, underlying medical conditions like thyroid dysfunction, heart disease, or eating disorders, or lifestyle habits like marijuana, poor exercise or other social determinants of health can severely complicate recovery. There are also genetic variables; for instance, researchers have identified that some individuals have genetic variations that interfere with the synthesis of serotonin substrates, contributing directly to biological treatment resistance.

Q: Are there alternative treatments for depression if standard medications fail? A: Yes. When traditional antidepressants are ineffective, patients require med trials of at least 6 weeks involving different treatment strategies. Depending on a clinician’s assessment, options may include switching to a different class of antidepressant, combining medications, or exploring non-pharmacological interventions like specialized psychotherapy, TMS, or Electroconvulsive Therapy. A comprehensive diagnostic reassessment is highly recommended before starting alternative treatments to ensure the new strategy aligns perfectly with the patient’s specific needs and health profile.

Q: Can misdiagnosis lead to treatment-resistant depression? A: Yes, misdiagnosis is a highly recognized risk factor for perceived treatment resistance. 79% of antidepressants in the United States are prescribed by primary care physicians, and not prescribed by mental health professionals with specialized psychiatric care. Some individuals who appear to have TRD are simply misdiagnosed and require a comprehensive psychiatric and medical reassessment. Diagnostic re-evaluations are essential for proper management, as uncovering hidden psychiatric conditions (like bipolar disorder or personality disorders) or previously unidentified physical health issues can completely change the necessary treatment trajectory.