Treatment-Resistant Depression Program

Comprehensive, Cutting-Edge Therapies for Treatment-Resistant Depression

Depression is one of the leading causes of disability worldwide. During the COVID pandemic, in 2021, it is estimated that 1 in 3 U.S. adults experienced significant depressive symptoms. However, even with antidepressants, many of those patients do not completely achieve resolution and may need other forms of treatment. 

At Columbia, we have created a comprehensive and evidence-based suite of services to help patients who suffer from severe and treatment-resistant depression.  

All treatments start with a comprehensive evaluation for interventional neurotherapeutic services. The process may also include recommendations for changes in accompanying medications and therapy. Instead of looking at a single treatment, we aim to provide patients with a holistic and individualized roadmap for symptom improvement and recovery.

Our Services

Transcranial Magnetic Stimulation (TMS)

Transcranial magnetic stimulation (TMS) is a non-invasive treatment that uses a device with strong magnets which produce an oscillating magnetic field to stimulate specific parts of the brain for resistant cases of depression. TMS treatments can lead to significant symptom improvements from depression. TMS therapy may be an option for patients who have not benefitted from—or have not been able to tolerate—traditional antidepressants. 

• TMS was first FDA approved in 2008 for depression
• TMS treatments are typically covered by insurance
• Our program utilizes the first FDA-approved TMS device with neuro-navigation, which may optionally deliver individualized precision-medicine treatments with the person’s own brain imaging.
• TMS treatments are typically administered daily for six weeks
• Treatment sessions take one hour or less
• The treatment regimen is individualized and may vary based on clinical responses; for some patients, protocols for shorter sessions with higher frequency stimulation may be appropriate.
• TMS treatment is not appropriate for patients who have implanted metal or magnetizable devices in their head. Patients with a history of seizures require case-by-case evaluation. 

Intranasal Esketamine

Intranasal esketamine is a unique, highly effective antidepressant for treatment-resistant depression. Esketamine can also be helpful for the reduction of depression with suicidal thoughts. Like ketamine, esketamine is thought to work mostly via glutamate receptors, which may help patients who have not responded to traditional antidepressants.

Intranasal esketamine is administered by nasal spray in a monitored and structured clinical setting.  

• Intranasal esketamine was FDA approved in 2019 
• The treatment is typically covered by insurance.
• The initial course of care is typically eight weeks—requiring two treatments per week for four weeks, then one treatment per week for four weeks, followed by individualized treatment plans depending on the patient and clinical response.
• Each treatment day requires 2 hours of monitoring in a peaceful environment with clinical staff.
• Patients receiving this treatment typically experience mild sedation and dissociation. 
• Treatment is not appropriate for patients who have experienced psychosis or who have active substance abuse. 

IV Ketamine

Ketamine, given intravenously, has been used for decades as an effective and safe anesthesia. Psychiatric research has demonstrated IV ketamine at lower doses is also highly effective in treating a range of psychiatric disorders, including depression. This treatment works in a unique way via glutamate receptors (similar to its “cousin,” esketamine). 

• For IV Ketamine, patients receiving this treatment are monitored in an infusion suite with clinic staff. 
• IV Ketamine treatments are currently not FDA approved and are not typically covered by insurance.
• The typical initial infusion treatment course takes place over 2-3 weeks. Treatment course varies by patient, with individualized treatment plans based on clinical responses.
• Each treatment day requires approximately 1-2 hours, including infusion and post-infusion monitoring in a quiet and restful environment.
• Treatment is not appropriate for patients who have experienced psychosis or who have active substance abuse.

Electroconvulsive Therapy (ECT)

Electroconvulsive therapy (ECT) is one of the most effective treatments in psychiatry. First developed in the 1930s, with almost a century of research and improvements, current ECT treatments significantly differ from the dramatized demonstrations in movies. 

At Columbia Doctors, we use an evidence-based approach that provides the highest tolerability and clinical efficacy while minimizing side effects. ECT is done under anesthesia and with a muscle relaxant to minimize side effects.  

• ECT devices are FDA cleared, and the procedure is typically covered by insurance.
• Treatment is performed 2 to 3 times per week for approximately one month, though frequency varies depending on the individualized treatment program.
• Our patients are briefly admitted to the inpatient unit for safety and monitoring.
• Patients may need to be evaluated on a case-by-case basis if they have a history of:
  • Recent stroke or heart attack
  • Increased intracranial pressure
  • Active bleeding
  • Retinal detachment
  • Severe high blood pressure

Insurance and Associated Costs

Please verify with your insurance carriers about individual INP services and potential Out of Network benefit coverage or reimbursement. We will provide invoice statements for individual INP services.