Advanced depression care

Treatment-Resistant Depression Management in New York

Treatment-resistant depression describes depression that has not responded adequately to appropriate treatment trials. Definitions can differ by guideline, study and insurer.

Treatment-resistant depression is considered when depression has not improved enough after adequate treatment attempts. The next step begins by checking the diagnosis, dose, duration, adherence, bipolar symptoms, substance use, medical contributors, psychotherapy, and safety. Nao can coordinate medication changes, psychotherapy, Spravato evaluation, or specialty referral when appropriate. No advanced treatment is automatic.

When depression has not improved

A TRD review reconstructs which treatments were taken at an adequate dose and duration, whether they were taken regularly and why they ended. It also checks the diagnosis, bipolar symptoms, sleep, substances, medical contributors and safety. The next step may be optimization, switching, augmentation, psychotherapy or a specialist advanced-treatment assessment. Spravato, off-label IV ketamine, ECT and TMS are distinct options, not one interchangeable pathway. Clinical suitability and actual service availability must be established separately. No listed option is automatically the only treatment left.

Treatment-resistant depression assessment

Treatment-resistant depression describes depression that has not responded adequately to appropriate treatment trials. Definitions can differ by guideline, study and insurer. In many settings, the term involves inadequate response to at least two antidepressant trials at an adequate dose and duration. A careful review is more useful than a medicine count alone: it helps explain what was tried, why it did not help and which next step fits the person.

How treatment-resistant depression assessment works

Persistent depression can have several contributors. The original diagnosis, bipolar symptoms, sleep, substance use, medical illness, side effects and difficulty taking treatment all deserve review. Nonresponse does not mean that a person has failed. Different treatment options act through medicines, psychotherapy or brain stimulation, and more than one part of the plan may be needed.

Eligibility: Treatment-resistant depression assessment

Bring names, doses and dates of previous treatments, including whether they were taken regularly, caused side effects or produced partial benefit. The assessment reviews symptoms, function and safety, as well as previous therapy and relevant medical conditions. Insurance criteria for a particular advanced treatment may ask for a different documented history from the clinical assessment.

What to expect: Treatment-resistant depression assessment

Reconstruct previous treatment trials

Identify what changed during each medicine or therapy trial and why it ended. Pharmacy records, clinician notes and discharge summaries can help. A brief exposure stopped for intolerance is important history but is not automatically an adequate effectiveness trial.

Discuss the next appropriate options

The psychiatrist may consider optimizing the current treatment, switching or adding treatment, a suitable psychotherapy or referral for ECT or repetitive transcranial magnetic stimulation. Spravato and off-label ketamine are distinct options with different indications and safeguards. No listed option is automatically available at Nao.

Set measurable goals and a review point

Agree on which symptoms and daily activities matter, how progress will be measured and when the plan will be reconsidered. Include a safety plan, side-effect monitoring and a contact if depression worsens.

Preparing for your appointment

Bring the treatment timeline, current medicine list and goals for sleep, work, relationships or self-care. Explain any history of unusually high energy, much less need for sleep, impulsivity or psychosis. Include relevant substance use, pregnancy concerns and previous brain-stimulation or ketamine treatment. Ask which records are needed before an advanced-treatment assessment and which costs are associated with it.

Risks and when to seek help

Worsening depression, suicidal thoughts, mania or psychosis require prompt assessment. An immediate threat to safety needs emergency care. Do not stop antidepressants abruptly, combine leftover medicines or increase a dose to accelerate improvement. Every proposed option has its own contraindications and adverse effects. Spravato has monitored-visit and transport requirements. Ketamine psychiatric use is off-label. Brain stimulation has a separate specialist assessment.

Follow-up and treatment review

Review changes in symptoms and daily function rather than relying only on an initial impression. Tell the team about side effects and missed treatment so the assessment reflects the real exposure. Partial improvement can lead to a different next step from no response or poor tolerability. A maintenance and relapse plan remains necessary after improvement.

Appointments, costs and coverage

Ask whether the visit is a diagnostic review, medication follow-up or assessment for a specific advanced treatment. Confirm referral requirements, records, benefit checks and the actual treatment site. Coverage of an evaluation does not establish coverage of ECT, TMS, Spravato or off-label infusions. Ask which advanced options are offered onsite and which need referral.

Spravato Treatment Locations in NYC and Long Island

Long Island City (LIC)

30-07 36th Ave, Long Island City, NY 11106

Confirm evaluation and treatment appointments with the service.

Call the clinic: (917) 310-3371

Mineola, Long Island

135 Mineola Blvd, Mineola, NY 11501

Confirm evaluation and treatment appointments with the service.

Call the clinic: (917) 310-3371

Williamsburg, Brooklyn

308 Graham Ave, Brooklyn, NY 11211

Confirm evaluation and treatment appointments with the service.

Call the clinic: (917) 310-3371

Manhattan, NYC

259 1st Ave, New York, NY 10003

Confirm evaluation and treatment appointments with the service.

Call the clinic: (917) 310-3371

Bartow, Bronx

2063A Bartow Ave, Bronx, NY 10475

Confirm evaluation and treatment appointments with the service.

Call the clinic: (917) 310-3371

Hicksville, Long Island

232 W Old Country Rd, Hicksville, NY 11801

Confirm evaluation and treatment appointments with the service.

Call the clinic: (917) 310-3371

Jamaica, Queens

90-18 Sutphin Blvd, Jamaica, NY 11435

Confirm evaluation and treatment appointments with the service.

Call the clinic: (917) 310-3371

Astoria, Queens

37-15 23rd Ave, Astoria, NY 11105

Confirm evaluation and treatment appointments with the service.

Call the clinic: (917) 310-3371

Crown Heights, Brooklyn

341 Eastern Pkwy, Brooklyn, NY 11216

Confirm evaluation and treatment appointments with the service.

Call the clinic: (917) 310-3371

These nine Nao Medical locations provide Spravato services. Confirm evaluation and treatment appointments, medication arrangements and plan requirements with your selected service.

Request a Spravato evaluation Ask about insurance benefits

Questions about your care

Why do I need bipolar screening?

Periods of reduced need for sleep, unusually high energy, impulsivity or mania/hypomania can change the diagnosis and medication plan. Tell the clinician about those episodes, family history and past responses to antidepressants. Bipolar treatment needs its own review. A depression score alone does not determine whether an antidepressant-only plan is appropriate. Do not stop or add medicine without that discussion.

Can the evaluation be virtual?

An appropriate evaluation or follow-up may be possible by video when the clinician is authorized to treat you where you are physically located. The service must confirm age, eligibility and current prescribing requirements. A video visit does not guarantee a controlled-substance prescription. Some examinations and tests need an in-person visit. Provider-administered injections require the appropriate treatment setting. Ask intake where any ordered specimens must be collected. Tell intake your actual location and requested service.

When is depression an emergency?

Use emergency care for an immediate threat to safety, severe confusion, inability to care safely for yourself, or dangerous manic/psychotic symptoms. Call 911 for immediate danger. An online medication-management appointment is not an emergency service. For non-immediate worsening, contact the treating clinician promptly and describe symptoms and medication gaps.

What if the medicine helped and then depression returned?

Contact the treating team for a review of symptoms, safety, adherence, new stressors, interactions and the ongoing treatment plan. Recurrence does not by itself identify the next medicine.

Can I qualify clinically and still have insurance deny Spravato?

Yes, clinical eligibility and insurer authorization are separate processes. Ask which documented trials and services the plan requires and what appeal process is available.

What should I bring for an initial treatment-resistant depression review?

Bring the names, doses and dates of previous antidepressants, what helped, side effects, and relevant psychiatric records. Ask which records can be sent securely before the evaluation.

How is treatment-resistant depression assessed before treatment-resistant depression care?

Treatment-resistant depression generally describes depression that has not responded adequately to at least two antidepressants tried at an adequate dose and duration. A clinician must review the diagnosis and treatment history.

Where does Nao Medical provide Spravato for patients considering treatment-resistant depression care?

Nao Medical’s confirmed Spravato service locations are Long Island City (LIC), Mineola, Long Island, Williamsburg, Brooklyn, Manhattan, NYC, Bartow, Bronx, Hicksville, Long Island, Jamaica, Queens, Astoria, Queens, Crown Heights, Brooklyn. Confirm the appointment and plan requirements with the selected service.

More information about treatment and visits

What does treatment-resistant depression mean? Do I have to try more medication before advanced treatment? Is Spravato the only treatment for TRD? Does Nao guarantee Spravato or another advanced treatment?

What records should I bring?

Bring medicine names, doses, bottles or a pharmacy list, previous clinician notes and recent tests. Make a short list of the benefits and problems that matter most to you. Tell the clinician about pregnancy, breastfeeding, allergies, medical illness and a recent change in smoking or substance use. For video care, use a private location and confirm a backup connection and current physical address.

Explain why each medicine was started, how you take it and what has changed. Include nonprescription medicines, supplements, alcohol and other substances. Discuss any uncertainty about the diagnosis or the reason for a combination.

Describe changes in sleep, mood, concentration, voices, energy and daily activities. Report side effects even when symptoms improve. Depending on the medicine, the plan may include vital signs, weight, laboratory testing, movement checks or an ECG.

Confirm the prescribed regimen, any gradual change, test orders, refill process and next review. Ask whom to contact if a symptom worsens or the pharmacy cannot supply the medicine. A change should have a documented reason and monitoring plan.

Medical sources

How Nao builds a next-step depression plan

1. Reconstruct prior care

Review medication and psychotherapy trials, dose, duration, adherence, side effects, symptom change, hospital care, and prior advanced treatments.

2. Reassess diagnosis and safety

Evaluate current depression severity, bipolar or psychotic symptoms, substance use, medical contributors, suicide risk, supports, and level-of-care needs.

3. Compare appropriate options

Discuss medication optimization or augmentation, psychotherapy, Spravato, TMS, ECT referral, or other care based on the individual record.

4. Measure and adjust

Set target symptoms, a follow-up interval, side-effect and safety monitoring, coordination responsibilities, and clear criteria for changing the plan.

Virtual psychiatry with coordinated local support