Treatment-Resistant Depression
Treatment-resistant depression (TRD) is depression that has not improved enough after at least two adequate trials of antidepressant medication. It is common, it is not a verdict on you, and it is the condition for which the most new options exist: Spravato (esketamine), ketamine-assisted psychotherapy, and medication management guided by genetic and lab data. MindMorph treats TRD by secure video across Colorado and Oregon, and in person in Lakewood, CO from December 1, 2026.
Integrative Psychiatry InstituteCertified Psychedelic-Assisted Therapy Provider (opens in a new tab)Ketamine therapy and Spravato are options we offer when antidepressants have not been enough, informed by Masha's Integrative Psychiatry Institute training. Read about ketamine therapy
What treatment-resistant depression is
The working definition in psychiatry is practical rather than biological: major depression that persists despite two or more antidepressants taken at an adequate dose for an adequate time. The label matters because it opens treatment doors; Spravato, for example, is FDA-approved specifically for adults with TRD.
TRD does not mean untreatable. More often it means that the thing driving the depression has not been found yet, or that the medications tried were not the right ones for your body. Contributing factors MindMorph looks for:
- Genetic variation in how antidepressants are metabolized, which pharmacogenomic testing can reveal
- Hormonal or thyroid imbalances
- Nutrient deficiencies (vitamin D, magnesium, folate, omega-3 fatty acids)
- Inflammation, chronic stress, or unprocessed trauma keeping the nervous system in a defensive state
- Sleep or circadian disruption that no one has treated as part of the depression
Comprehensive lab testing, pharmacogenomic analysis, and a long first conversation surface these layers, so the plan is a recalibration based on your biology rather than a fourth repeat of what has not worked.
Signs you may be living with TRD
- You have tried two or more antidepressants without significant relief
- Symptoms return quickly after an initial improvement
- Emotional blunting or chronic fatigue has become the baseline
- Anxiety and insomnia persist despite therapy or medication
- You feel disconnected, numb, or unable to find purpose, even when life is objectively fine
How MindMorph treats TRD
The plan pairs medical options with whole-person support, because TRD usually has both a neurochemical and an experiential side. Depending on your evaluation, it may include:
| Option | What it is | Status and setting |
|---|---|---|
| Spravato (esketamine) | Nasal spray acting on the glutamate system; some people notice change within days, others gradually | FDA-approved for TRD; in person in Lakewood from Dec 1, 2026, with two hours of monitoring; often covered by insurance |
| Ketamine-assisted psychotherapy | Low-dose sublingual ketamine inside a course of preparation and integration therapy | Off-label; in person in Lakewood from Dec 1, 2026; usually self-pay |
| Precision medication management | Prescribing guided by pharmacogenomic data and labs to cut the trial-and-error period | Office or telehealth in CO and OR |
| Trauma-informed therapy | Talk and somatic work on the shame, fear, or shutdown that can keep depression in place | Office or telehealth |
| Mindfulness and breathwork | Practices that help regulate the stress response and reconnect mind and body | Taught in session, practiced at home |
| Nutrition and supplements | Addressing deficiencies and inflammation that contribute to mood instability | Guided by lab results |
Results vary by individual, and no treatment on this list works for everyone. Which ones you try, and in what order, is decided together after the evaluation.
What a first visit looks like
It begins with a free consultation by video or phone. If MindMorph is the right place, the next step is a 90-minute initial psychiatric evaluation: a full history, every medication you have taken and what each one did, sleep, nutrition, stress, trauma history, and medical context. Bring records if you have them. Genetic and lab testing are ordered at that visit when they are likely to change the plan, and you leave with a written one. Follow-ups run every two to four weeks while things are being adjusted.
Cost and insurance
MindMorph is in network with a number of Colorado and Oregon plans for evaluation, medication management, therapy, and Spravato; the current lists and self-pay rates are on the insurance and payment page. Ketamine-assisted psychotherapy is self-pay with a superbill. Coverage cannot be guaranteed, and benefits are verified before your first appointment.
The MindMorph difference
Many clinics stop at the prescription. Here, biology, psychology, and lifestyle are one system of care, held by one clinician: a dual board-certified psychiatric and family nurse practitioner who does the evaluation, the prescribing, the Spravato supervision, and the therapy. Depression is treated as a state the whole body-mind has settled into rather than a chemical defect to be corrected, so the way out involves the whole of it too.
In practice that means Spravato, FDA-approved for treatment-resistant depression, supervised in person at the Lakewood office from December 1, 2026. It means ketamine-assisted psychotherapy as an off-label option when it fits, and pharmacogenomic testing so the next medication is chosen on evidence instead of guessed. Nutrition, mindfulness, and somatic therapy are written into the same plan, and the setting is a private, quiet room for people who are tired of waiting rooms.
Next step
If you have tried everything and still feel stuck, there are options you have not tried, and the consultation is free. Book a consultation or call (720) 504-2181.
If you are in crisis, call or text 988 (Suicide & Crisis Lifeline) or call 911. This practice does not provide emergency services.
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Questions
Treatment-resistant depression is major depression that has not adequately improved after at least two different antidepressant trials at proper doses for proper durations. Resistant does not mean untreatable: it has its own treatment options, including Spravato, which is FDA-approved specifically for it, and ketamine-assisted psychotherapy, an off-label option, both given in person in Lakewood from December 1, 2026.
Evidence-based next steps include Spravato (esketamine), an FDA-approved nasal spray taken in the office; ketamine-assisted psychotherapy, an off-label sublingual treatment; a medication strategy change guided by pharmacogenomic and lab testing; and intensive trauma-informed therapy, often in combination. Which ones fit is decided after the evaluation, and results vary by individual.
Yes. Resistant does not mean untreatable; many people who have not responded to multiple medications respond to newer interventions delivered within an integrated plan. Often the missing piece is a cause no one looked for, such as how you metabolize a drug, a thyroid or nutrient problem, untreated sleep disruption, or trauma. No outcome can be promised.
Some patients notice a shift within hours to days of ketamine-based care, while others improve gradually and some do not respond. Full assessment of response takes weeks, and therapy remains essential to consolidate whatever gains appear. Spravato and ketamine-assisted psychotherapy are both given in person in Lakewood, with monitoring, from December 1, 2026.
Sometimes. Pharmacogenomic testing shows how your body metabolizes specific medications, which can explain why a previous drug did little or caused side effects at an ordinary dose. It does not pick the medication for you, but it narrows the choices. MindMorph orders it when the result is likely to change the plan.
Evaluation, medication management, therapy, and Spravato are often covered; MindMorph is in network with a number of Colorado and Oregon plans and handles prior authorization for Spravato. Ketamine-assisted psychotherapy is an off-label service and is self-pay with a superbill. Current lists and rates are on the insurance and payment page. Coverage cannot be guaranteed.