Psychiatry

Treatment-Resistant Depression Program

Image of doctor and female patient

COVID-19 Update: As the COVID-19 pandemic unfolds, we believe that it is important to be present for our community and to continue to provide services to patients suffering from mood and anxiety disorders. During this health emergency, we will provide telehealth services using HIPAA compliant platforms. We are offering in-person visits for esketamine and TMS treatments with precautions to minimize the risks to our patients. We are also able to provide the following  services: initial psychiatric evaluations for patients suffering from symptoms of depression and anxiety; psychiatric psychopharmacology consultations; and longitudinal follow-ups with one of our psychiatrists for both medication management and/or therapy, if deemed appropriate after initial evaluation.

Depression is the #1 cause of disability across the world, and approximately 10.4 percent of U.S. adults experience it in any given year. Occasionally, people experience depression that has not responded to typical therapies, such as talk therapy or medication. Studies show that more than one in three patients with depression fail to respond to two or more antidepressant trials—in other words, they have treatment-resistant depression (TRD).

At Mount Sinai, we focus on safe, innovative approaches to mental health care. We have a specialized approach if you haven’t responded to typical depression treatments, and the first step is a thorough evaluation.

How We Evaluate for Treatment-Resistant Depression

Because treatment-resistant depression is complex and can stem from a variety of causes, we need to start with a careful evaluation to gather as much information as possible. To create the best plan for you, we take a deep look at your past and current symptoms and previous treatments. Then, we use questionnaires to assess your current state of mind. If needed, we also use lab tests, genetic testing, and brain imaging. Once we have gathered as much information as possible, we will consult with you about your next steps in the process.

Our Treatment Options

The below options may be part of our recommended plan for depression in patients who have not responded to conventional methods.

  • Esketamine nasal spray: Esketamine is delivered via nasal spray and was approved by the FDA in 2019 for treating TRD in adults in combination with an oral antidepressant. We are the first major academic medical institution in New York City to offer esketamine (SPRAVATO™ CIII nasal spray)* for TRD.
  • Electroconvulsive therapy (ECT): ECT uses an electrical current in the brain while the patient is under general anesthesia. Doctors believe that this may help the brain "rewire" itself, which helps relieve symptoms. Mount Sinai has a well-established inpatient and outpatient ECT service, headed by Amy Aloysi, MD, MPH.
  • Deep brain stimulation (DBS): Performed by neurosurgeons at the Center for Neuromodulation, DBS involves pinpointing (via brain scans) the exact spot in the brain that is causing the depressive symptoms. A neurosurgeon implants two electrodes into that area, which connects to a neurostimulator. The neurostimulator is implanted just under your skin, near the collarbone—like a pacemaker. This enables us to send electrical currents to your brain to ease your symptoms. Once the device is placed, we program the location, amplitude, duration, and frequency of the electrical pulse for the best result. In collaboration, the Nash Family Center for Advanced Circuit Therapeutics develops bold, new approaches for the treatments, looking beyond pharmacological therapies to focus on understanding and correcting the circuit-based mechanisms of major depression.
  • Intensive medication management, therapy, and more: We use a range of evidence-based options with an emphasis on personalized care; these can include medications, individual cognitive behavioral therapy, intensive outpatient therapy, and group therapy. 

To schedule an evaluation, please reach out to Julia Clark at dac@mssm.edu or 212-241-6539.

*Mount Sinai was involved in the research that led to the development of this new treatment method for treatment-resistant depression and receives financial remuneration from the manufacturer of SPRAVATO. Mount Sinai's Dean is a co-inventor of patents related to this new treatment method and as such receives remuneration through Mount Sinai from the manufacturer. For more information about these financial interests and Mount Sinai's leadership role in SPRAVATO, please visit bit.ly/esketamine-development.