top of page

Major Depression vs Treatment Resistant Depression How we adjust care in Texas

  • Writer: Moe | Scarlet Plus
    Moe | Scarlet Plus
  • Oct 21
  • 5 min read

If you are hurting from depression, you are not alone. Many people in Texas live with major depression. Some also face treatment resistant depression. Treatment resistant depression is sometimes called TRD. It means your symptoms keep going even after good tried treatments. We adjust care so you can feel better with a clear plan that fits your life. (National Institute of Mental Health)


A man sits on a beige couch, looking stressed with hand on forehead, while a woman talks to him, holding a notebook, in a bright room.
A person is having a thoughtful conversation with a therapist in a cozy setting, reflecting a moment of introspection and guidance.

First, what major depression means

Major depression affects how you feel, think, and act. It can cause low mood, loss of interest, sleep and appetite changes, low energy, trouble focusing, and thoughts of death. Symptoms last for at least two weeks and cause real problems in daily life. This is the standard way doctors define a major depressive episode. (National Institute of Mental Health)

Depression is common and it can be treated. Many people improve with talk therapy, medicine, or both. Some also need other treatments. The National Institute of Mental Health explains these options in plain language. (National Institute of Mental Health)


What treatment resistant depression means

Treatment resistant depression means a person with major depression did not get enough relief after at least two good trials of antidepressant medicine. Good trials means the right dose and enough time with medicine taken as directed. Many specialists and the Food and Drug Administration use this as the working definition. Up to three in ten people with depression may meet this definition. (PubMed)

Some people look treatment resistant when the real issue is different. Doctors call this pseudo resistance. Common causes include too low a dose, not enough time on a medicine, missed doses, other medical problems, or a different diagnosis such as bipolar disorder. Sorting this out matters because it guides the next step. (PMC)


How we tailor care at Adelson Behavioral and Mental Health

Our goal is clear. We build a plan around you. We serve Arlington, Dallas, Fort Worth, and Mansfield. Here is how we adjust care at each step.


We start with time and listening

Your first visit with our team is a full hour. We ask about your story, your symptoms, past care, and what has helped even a little. This helps us form a clear diagnosis and plan. (Adelson Psychiatry)


We measure what matters

We use symptom checklists and simple mood scales. We track sleep, energy, focus, and daily function. Small gains count. Clear measures help us choose the next step with you. Guidance from the National Institute of Mental Health supports this approach. (National Institute of Mental Health)


If you have major depression and are early in care

Many people start with talk therapy, medicine, or both. Therapies like cognitive behavioral therapy help you challenge unhelpful thoughts and build skills. First line medicines include SSRIs and SNRIs. Your plan depends on your goals, other health needs, and side effect risks. (National Institute of Mental Health)


If symptoms continue after first steps

If you still have symptoms after a solid trial, we make careful changes.

  1. We confirm the diagnosis and check for other conditions.

  2. We review dose, duration, and daily use.

  3. We look for medical issues that can worsen mood such as thyroid problems or sleep issues.

  4. We consider a switch to another antidepressant or an add on strategy like bupropion or an atypical antipsychotic.

  5. We add or adjust therapy since therapy helps at every stage. (National Institute of Mental Health)


Options for treatment resistant depression

If you meet criteria for treatment resistant depression, more tools are available and many people improve with the right mix.

  1. Esketamine nasal spray. The FDA approves esketamine for adults with treatment resistant depression. It is given in a clinic with monitoring and is used with an oral antidepressant or as monotherapy as directed by the current label. We discuss benefits, safety, and whether it fits your health needs and insurance. (FDA Access Data)

  2. Brain stimulation therapies. These include electroconvulsive therapy and transcranial magnetic stimulation. These treatments activate or quiet brain circuits linked to mood. They can help when symptoms are severe or long lasting. The National Institute of Mental Health provides clear information on how they work and who may benefit. (National Institute of Mental Health)

  3. Therapy plus medicine. Even in treatment resistant depression, adding therapy like cognitive behavioral therapy can improve outcomes and coping. (National Institute of Mental Health)


We provide medication management, therapy, and coordinated care. You can read more on our Treatment Resistant Depression page and our Depression page on this site. (Adelson Psychiatry)


Safety first during advanced care

We review all medicines you take. We look for drug interactions. We plan follow up visits to watch progress and side effects. If you start esketamine or a brain stimulation therapy, we set clear safety steps and a schedule that works for you. We also help with insurance forms when needed. FDA labeling guides our safety checks for esketamine. (FDA Access Data)


What progress can look like

With many antidepressants, early change may take two to four weeks. Full benefit can take six to eight weeks. If there is no change after a fair try, we adjust. If there is a small change, we may optimize dose or add therapy. The key is steady review and shared decisions. NIMH explains timelines and why follow up matters. (National Institute of Mental Health)


Everyday steps that support recovery

Care plans work better when daily life supports them.

  1. Keep a regular sleep and wake time.

  2. Eat balanced meals and drink water through the day.

  3. Move your body most days. Short walks count.

  4. Limit alcohol and avoid non prescribed drugs.

  5. Build a small support circle.

  6. Use simple mood tracking. One number a day is enough.

These steps do not replace treatment. They strengthen it. NIMH offers self care tips in its depression resources. (National Institute of Mental Health)


When to seek urgent help

If you have thoughts of harming yourself or others, get help now. In the United States you can call or text 988 for the Suicide and Crisis Lifeline. You can also chat online. Help is available day and night. If there is immediate danger, call 911. (988 Lifeline)


Care near you in North Texas

We serve Arlington, Dallas, Fort Worth, Mansfield, and nearby communities. We offer same week evaluations when possible and flexible follow up choices. Book an appointment and we will help you find the next right step. (Adelson Psychiatry)


What to expect at Adelson Behavioral and Mental Health

  1. A one hour first visit focused on your story and goals.

  2. A clear plan that may include therapy, medicine, or both.

  3. Review at each visit with simple measures so you see progress.

  4. Fast action if symptoms stay strong. We adjust treatment and consider advanced options that fit your needs. (Adelson Psychiatry)


Key takeaways about treatment resistant depression

Treatment resistant depression means limited relief after at least two good trials of antidepressants. It is common but treatable. Advanced options like esketamine and brain stimulation can help many people. A careful plan and close follow up increase your chance of feeling better. (PubMed)


Ready to talk with someone who listens.

Reach out to Adelson Behavioral and Mental Health today. If you are in crisis now, call or text 988.



bottom of page