What is treatment-resistant depression?
Treatment-resistant depression broadly means depression that has not improved enough after adequate trials of two or more antidepressants at proper doses and durations. Roughly a third of people with depression fit this description at some point. It is common, it is not a personal failing, and it usually points toward a different type of treatment rather than simply trying another pill. There is more in our guide to depression treatment options.
How long should an antidepressant take to work?
Most antidepressants such as SSRIs and SNRIs take about four to eight weeks at an adequate dose to show their full effect. Sleep and appetite sometimes improve before mood does. If you have taken a medication consistently for six to eight weeks with little change, that is worth discussing with your prescriber rather than stopping on your own. See signs your antidepressant is not working for more.
What is TMS and how does it work?
TMS, or transcranial magnetic stimulation, is a non-invasive, FDA-cleared treatment that uses focused magnetic pulses to stimulate areas of the brain involved in mood. There is no medication and no anesthesia. You sit awake in a chair during short sessions on most weekdays over roughly four to six weeks, and you can drive yourself and return to normal activities right afterward.
What is esketamine (Spravato)?
Esketamine, sold as Spravato, is an FDA-approved nasal-spray medication for treatment-resistant depression. It works through a different brain system than standard antidepressants, which is why it can help some people who have not responded to those. It is given under medical supervision in a certified clinic, used alongside an oral antidepressant, and patients are monitored for about two hours after each dose.
What is the difference between TMS and esketamine?
TMS uses magnetic pulses with no medication and no post-session monitoring, so you can drive yourself home. Esketamine is a nasal-spray medication that can cause temporary drowsiness or a dissociated feeling, so you are monitored afterward and need someone else to drive you home. Both are FDA-supported options for depression that has not responded to standard antidepressants, and the right choice depends on your history and your clinician's recommendation. Our full TMS vs esketamine comparison covers this in detail.
Does insurance cover TMS or esketamine in Missouri?
Many insurance plans cover TMS and esketamine for treatment-resistant depression, though coverage rules and prior-authorization requirements vary by plan and clinic. Some Missouri clinics accept MO HealthNet, the state Medicaid program. Because coverage differs, the most reliable step is to ask a specific clinic what your plan will approve and what you would owe.
Can I get depression treatment in Missouri if I have MO HealthNet or no insurance?
Yes. Missouri's community mental-health centers and federally qualified health centers are built to serve people on MO HealthNet or without insurance, offering therapy, psychiatry, and medication management, often on a sliding-fee scale. Some specialty clinics also accept MO HealthNet for advanced treatments. These are real options, not last resorts. You can browse programs in our provider directory.
Is esketamine the same as the ketamine sold recreationally?
No. Esketamine (Spravato) is a specific, FDA-approved prescription medication derived from ketamine, given as a nasal spray in a certified clinic under medical supervision and combined with an oral antidepressant. It is a regulated medical treatment for treatment-resistant depression, not the same as recreational use.
What kind of doctor treats treatment-resistant depression?
Psychiatrists and psychiatric nurse practitioners diagnose and manage treatment-resistant depression and can prescribe or oversee advanced treatments. Specialty clinics focus specifically on TMS and esketamine. Your primary care doctor is often the easiest starting point because they can screen you, begin treatment, and refer you to a specialist when standard care has not been enough. Our guide on choosing the right provider can help you decide where to begin.
How do I start if I think I need help?
The simplest strong first step is to tell your own primary care doctor what you have experienced and what you have already tried, and ask what they recommend. A recommendation from a doctor you trust is the single most common reason people finally follow through on care. If you are in crisis, call or text 988 at any time.