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Conditions · Positioning Keystone

Treatment-Resistant Depression in Portland, Maine

Two medications in, still depressed — that's not a personal failure, it's a clinical category with its own playbook. This practice was built around it.

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Written by the Bishop Health clinical team · Medically reviewed by Tamer Wassef, MD
Published August 15, 2026 · Last reviewed August 15, 2026

Treatment-resistant depression (TRD) is major depression that hasn't adequately improved after trying at least two different antidepressants at proper doses and durations. It affects roughly a third of people treated for depression, and it responds to a different toolkit — TMS, esketamine, and structured programs — all available at Bishop Health in South Portland.1

Does This Sound Like Your Depression?

Not a diagnosis — a pattern check. The more of these fit, the more a TRD-focused evaluation is worth your time.

○You've tried two or more antidepressants without lasting relief
○Each new medication helps briefly, then fades
○Side effects keep forcing you to stop before a fair trial
○Therapy helps you cope but the weight never lifts
○Mornings are the hardest part of every day
○You function at work, then collapse at home
○You've stopped believing anything will work — and stopped mentioning it
○Sleep, appetite, and concentration stay off even on medication
○Someone close to you has started using the word "still" — still struggling, still not better

Why Depression Resists Treatment

•Biology: some depression involves circuits that SSRIs don't reach — the rationale behind TMS and esketamine treatment2
•Misdiagnosis: unrecognized bipolar depression, ADHD, or thyroid issues masquerading as "resistant" depression
•Under-dosing: trials that were too short or too low to count as real trials
•Unaddressed trauma or co-occurring anxiety pulling against the medication
•Life load: grief, seasonal darkness, isolation — Maine winters are a real variable

When to Seek a TRD Evaluation

After the second adequate medication trial that hasn't worked — not the fifth. Every additional failed trial costs months; the interventional options exist precisely for this point in the story.

How Bishop Health Treats TRD

Your evaluation routes you to the right tool — this is the map.

IOP / PHP →When depression needs daily structure, not just weekly appointments.TMS Therapy →Drug-free, insurance-covered, drive yourself. First choice for many after medication failures.Spravato (Esketamine) →FDA-approved for TRD specifically; faster-acting, typically covered with prior auth.Medication Review →A real audit of past trials — augmentation and combinations before writing anything off.

TRD Questions, Answered

How is TRD actually diagnosed?

By history, not a test: major depression plus at least two adequate antidepressant trials — right dose, right duration — without sufficient response. Your evaluation also screens for look-alikes: bipolar depression, thyroid problems, sleep apnea, ADHD.

Is TRD common, or is it just me?

Roughly one in three people treated for depression meets criteria at some point. The isolation of it is part of the illness; the prevalence is why an entire treatment category exists.

Which interventional option would I start with?

Usually TMS if you want drug-free with zero downtime, Spravato if speed matters and you can arrange rides. See the honest comparison →

Does insurance treat TRD differently?

Yes — in your favor. Documented failed trials are exactly what insurers require to authorize TMS and Spravato. Your history of what didn't work becomes the paperwork that unlocks what might.

Can TRD get better after years — or is chronic just chronic?

Duration doesn't disqualify you. Response rates to TMS and esketamine hold up in people with long-standing depression — several of our strongest recoveries came after a decade of "nothing works."

What if I'm having thoughts of suicide?

Don't wait for an evaluation — use the crisis lines below, or 911 if you're in immediate danger. If you're safe but the thoughts are present, say so on your admissions call; it changes how fast we schedule you and which treatments we consider first.

References

  1. Rush AJ, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. American Journal of Psychiatry. 2006;163(11):1905–1917.
  2. Gaynes BN, et al. Defining treatment-resistant depression. Depression and Anxiety. 2020;37(2):134–145.