Questions & Answers
Depression treatment, answered
These are the questions people in the St. Peters and St. Charles County area actually ask about depression, antidepressants, and newer treatments. The answers are short, honest, and in plain English. None of this is medical advice, but it should help you feel more prepared for a conversation with a real provider.
How do I know if my depression is treatment-resistant?
Depression is often called treatment-resistant when you have tried at least two different antidepressants, each at an adequate dose and for a long enough time, and your symptoms still have not lifted. It happens to roughly a third of people who try antidepressants, and it does not mean you failed. It is a signal to ask your doctor about different approaches. Our guide on when antidepressants aren't working covers this in depth.
How long do antidepressants take to work?
Most antidepressants need about four to eight weeks at a full dose before you can fairly judge whether they are helping. A low dose or a short trial can look like failure when the medication was never really given a fair test. If you have given it enough time and still feel no better, that is worth discussing with your doctor.
What is Spravato and how does it work?
Spravato is the brand name for esketamine, a prescription nasal spray that is FDA-approved for adults with treatment-resistant depression. It works on a brain chemical called glutamate rather than serotonin, which is why it can begin to help some people faster than traditional antidepressants. It is given in a certified clinic under medical supervision, not taken at home. See our full Spravato explainer for what a session is like.
What is TMS therapy?
TMS, or transcranial magnetic stimulation, is a drug-free, non-invasive treatment that uses gentle magnetic pulses to stimulate mood-related areas of the brain. It is FDA-approved for depression that has not responded to medication. You stay awake, there is no anesthesia, sessions run about twenty to forty minutes, and a typical course is five days a week for around four to six weeks. Our TMS guide walks through the details.
Is Spravato or TMS covered by insurance in Missouri?
Both Spravato and TMS are FDA-approved treatments and are covered by many insurance plans when someone meets the criteria, and some clinics in the St. Charles County area accept most insurance, including MO HealthNet. Coverage always depends on your specific plan and situation, so the best step is to ask the clinic to verify your benefits before you start.
Is Spravato the same as ketamine?
They are closely related but not identical. Esketamine, the active ingredient in Spravato, is one part of the ketamine molecule. Ketamine has been used safely in medical settings for decades. Spravato is the specific, FDA-approved nasal spray form developed and approved for treatment-resistant depression and given under supervision.
Should I stop my antidepressant if I start Spravato or TMS?
No. Spravato is generally used alongside an oral antidepressant, and TMS is often combined with ongoing medication as well. Never stop or change a psychiatric medication on your own, because doing so can cause withdrawal effects or a return of symptoms. Any changes should be made with the provider who is managing your care.
How do I bring up treatment-resistant depression with my doctor?
Keep it simple. You can say something like: "I have tried medication and I still feel depressed. What else is out there, and am I a candidate for anything like Spravato or TMS?" A recommendation from your own doctor is the single biggest factor in whether people try a new treatment, so starting that conversation matters.
Where can I get help for depression in St. Peters or St. Charles County?
Good starting points include your primary care doctor, community providers such as Compass Health Network and Preferred Family Healthcare, and your insurance provider directory for covered therapists. For depression that has not responded to medication, a doctor-supervised clinic in the St. Charles County area can assess whether Spravato or TMS is an option. Our local help guide lists the options.
What should I do if I am in a mental health crisis right now?
Call or text 988 to reach the Suicide and Crisis Lifeline, which is free, confidential, and available around the clock. Veterans can press 1 for the Veterans Crisis Line. In the St. Louis area you can also call Behavioral Health Response at 1-800-811-4760. If someone's life is in immediate danger, call 911 and say it is a mental health emergency.
These answers are general information for the St. Peters and St. Charles County, MO community. Details can change over time. This is not medical advice - please confirm current information directly with a licensed provider.