Houston Mind & Brain Blog: Psychiatry, TMS & Mental Health in Houston

Treatment for Treatment-Resistant Depression: What It Is, What Causes It, and What to Try Next

Sat, 03 Oct 2026 20:49:54 GMT

Treatment for Treatment-Resistant Depression: Your Options

You did what you were supposed to do. You saw a doctor, started an antidepressant, and gave it time. When it didn't help, you tried another. Maybe a third. And you still don't feel like yourself.

If that sounds familiar, you're not alone, and you haven't failed treatment. In STAR*D , the largest real-world study of depression treatment, about a third of people still hadn't recovered after four rounds of treatment. Researchers estimate that about 2.8 million U.S. adults taking medication for depression, nearly 1 in 3, have treatment-resistant depression. When antidepressants aren't working, doctors call it treatment-resistant depression, and it's one of the most active areas of research in psychiatry.

This guide explains what treatment-resistant depression means, what causes it, how to tell whether it applies to you, and the treatment for treatment-resistant depression available when your depression medication isn't working.

Key points

Treatment-resistant depression means depression that hasn't improved enough after at least two antidepressants, each given a fair trial.
It's common: nearly 1 in 3 people taking medication for depression have it.
It isn't permanent, and it isn't your fault. Sometimes earlier treatment never got a fair chance.
Options include different medications, TMS, Spravato, ketamine-assisted psychotherapy and therapy. Many people do best with a combination.
If you're having thoughts of suicide, call or text 988.

What Is Treatment-Resistant Depression? The Definition

The standard definition of treatment-resistant depression (TRD) is major depression that hasn't improved enough after at least two different antidepressants. Each one needs to have been taken at an adequate dose for an adequate length of time, usually at least four to eight weeks. The FDA, European regulators and most insurance plans use this definition, as summarized in a 2023 international expert review in World Psychiatry.

You may also see it called treatment-refractory depression or medication-resistant depression. All three terms mean the same thing.

It also covers partial improvement. If a medication took the edge off but you never felt fully well, that ongoing gap is still a reason to look at other options.

The name can sound like a verdict on you. It isn't. It means the medications you've tried so far weren't the right fit for your brain, not that you did something wrong or that nothing will work.

Is It Really Treatment-Resistant? What to Check First

Before deciding your antidepressants aren't working, it's worth asking whether each one got a fair chance. Doctors have a name for depression that only looks treatment-resistant: pseudo-resistance. The 2023 expert review notes that a significant share of people labeled treatment-resistant fall into this group, usually because earlier medication trials weren't adequate or the medication wasn't taken consistently.

A careful evaluation often turns up one of these:

The dose was too low, or the trial too short. Many people stop a medication at its starting dose, or after two or three weeks, before it could fully work.
Side effects ended it early. A medication you couldn't tolerate isn't the same as one that didn't work.
The diagnosis needs a second look. Bipolar depression can look like ordinary depression but responds differently to antidepressants. Missing it is a common reason treatment stalls.
Something else is keeping depression going. A thyroid problem, sleep apnea, chronic pain, alcohol or substance use, or untreated anxiety, ADHD or PTSD can all hold recovery back.
Life is adding weight. Ongoing stress, trauma or grief can keep symptoms going even when a medication is doing its part.

This is why a specialist evaluation matters before the next step. Looking closely at what you've tried (the doses, how long, and what happened) often changes the plan.

What Causes Treatment-Resistant Depression?

There's no single cause of treatment-resistant depression. Researchers think several factors often work together:

Brain circuit differences. Depression involves networks of brain regions that regulate mood. In some people, these circuits don't respond well to medications that work mainly through brain chemicals like serotonin. That's one reason treatments that act on brain circuits directly, like TMS, can help when pills haven't.
Genetics and metabolism. Your genes affect how fast your body breaks down medications. Some people clear certain antidepressants so quickly that a standard dose never reaches an effective level. International prescribing guidelines now recommend considering a different antidepressant for some of these fast metabolizers.
Inflammation and other medical factors. A 2015 review of 35 studies found that people who didn't respond to antidepressants tended to have higher inflammation before treatment started. Thyroid disorders, hormonal changes and chronic illness can also play a role.
Co-occurring conditions. Anxiety, PTSD, ADHD and substance use often travel with depression and make it harder to treat.
The course of the depression itself. Longer, more severe or repeated episodes are more likely to resist standard treatment.
Stress and trauma. People who experienced abuse or neglect as children are about twice as likely to have long-lasting or recurring depression. They're also more likely to respond poorly to both medication and therapy, according to a review of 26 studies in the American Journal of Psychiatry.

Many of these can be identified and addressed. Understanding why earlier treatment fell short is the first step toward choosing what comes next.

Treatment-Resistant Depression Symptoms: A Self-Check

Treatment-resistant depression doesn't have its own set of symptoms. It's the usual symptoms of depression that stay even after treatment: low mood or emptiness, loss of interest, fatigue, changes in sleep or appetite, trouble concentrating, feelings of worthlessness, and sometimes thoughts of death.

So the more useful question is whether your treatment so far has worked. Ask yourself:

Have I tried two or more antidepressants?
Did I take each one at a full dose for at least six to eight weeks?
Did I improve only partly, or feel better and then slip back?
Did side effects make it too hard to stay on a medication?

If you answered yes to the first two and still don't feel like yourself, you may have treatment-resistant depression. If you're not sure about the doses or how long you took each one, that's worth sorting out. It's the first thing a specialist will look at.

If you're having thoughts of suicide, call or text 988 to reach the Suicide & Crisis Lifeline, or go to the nearest emergency room.

Treatment for Treatment-Resistant Depression: Your Options

When antidepressants aren't working, there are more options than most people realize. The right one depends on your history, your symptoms and what fits your life.

A note on the research numbers below: response means symptoms dropped by at least half, and remission means they're nearly gone. Remission is a high bar, so more people improve in a meaningful way than the remission numbers alone suggest.

Treatment-Resistant Depression Medications

If earlier trials were too short or the dose too low, the first step may simply be giving a medication a proper trial. Beyond that, psychiatrists usually choose among four strategies:

Switching to a different type of antidepressant, such as an SNRI (venlafaxine or duloxetine), bupropion or mirtazapine. Older classes, like tricyclics and MAOIs, are still used when newer medications haven't worked.
Combining two antidepressants that work differently, such as adding bupropion or mirtazapine to an SSRI.
Adding an augmenting medication. Several antipsychotics are FDA-approved as add-ons to an antidepressant for depression, including aripiprazole (Abilify), brexpiprazole (Rexulti), quetiapine XR (Seroquel XR) and cariprazine (Vraylar) . Lithium and thyroid hormone are older add-on options.
A medication approved specifically for treatment-resistant depression. Olanzapine-fluoxetine (Symbyax) was the first, in 2009. Spravato, covered below, is the other.

Which strategy works best varies from person to person. In the VAST-D trial of veterans whose depression hadn't responded to an antidepressant, adding aripiprazole led to slightly more remissions (29%) than switching to bupropion (22%). Side effects matter too: add-on antipsychotics can cause weight gain and restlessness, and your provider will weigh that with you.

TMS (transcranial magnetic stimulation)

TMS uses focused magnetic pulses to stimulate the brain circuits involved in mood. It has been FDA-cleared since 2008 for adults with depression who haven't improved enough with antidepressant medication. It also holds up outside of research settings: in a study of 307 patients at 42 U.S. TMS practices , 58% responded to treatment and 37% reached remission, meaning few or no symptoms remained.

There's no anesthesia or downtime: you're awake during each session and can drive yourself home. For people who need a shorter schedule, accelerated TMS fits a full course into fewer days. Learn what to expect from TMS treatment .

Spravato (esketamine)

Spravato is a nasal spray approved by the FDA in 2019 specifically for treatment-resistant depression. Since January 2025 , it can be used on its own or alongside an oral antidepressant. In a 2023 head-to-head trial published in the New England Journal of Medicine, 27% of people using Spravato reached remission after eight weeks, compared with 18% of people who added quetiapine, a common add-on medication.

It's given only at certified clinics: you take it on site and stay for at least two hours of monitoring, and you can't drive until the next day. Learn more about Spravato at Houston Mind & Brain .

Ketamine-assisted psychotherapy (KAP)

Ketamine-assisted psychotherapy pairs a dose of ketamine (either Spravato or racemic ketamine) with therapy in the same session. The goal is to use the window ketamine opens to work through what's keeping you stuck. Racemic ketamine is used off-label for depression. Learn more about ketamine-assisted psychotherapy .

Ketamine itself has strong evidence behind it. In a 2023 trial of 403 people with treatment-resistant depression, 55% responded to ketamine. That trial gave ketamine by IV without therapy, so results for other forms may differ.

Psychotherapy

Therapy such as cognitive behavioral therapy (CBT) helps on its own and alongside medication or TMS. Many people do best with a combination rather than any single treatment. Learn about Psychotherapy at Houston Mind and Brain.

Other options

Vagus nerve stimulation (VNS), an implanted device, is FDA-approved for long-term treatment-resistant depression. Other treatments exist for severe depression that hasn't responded to the options above, and your provider can talk through whether any of them makes sense for you.

When Treatment-Resistant Depression Comes With Anxiety

Anxiety and depression often come together, and the combination can be harder to treat. In the STAR*D study, people with anxious depression were less likely to reach remission on their first antidepressant, and took longer to get there.

Some treatments address both. Deep TMS has been FDA-cleared since 2021 to reduce anxiety symptoms in adults with depression, based on data from 573 patients across 11 studies. Therapy approaches like CBT also work on both at once. If anxiety is a big part of what you're dealing with, learn more about our anxiety treatment in Houston .

Finding Treatment-Resistant Depression Treatment Near You

Yes, for most patients — though differently than stimulants. Non-stimulants build up gradually If you're in the Houston area and antidepressants haven't worked, you don't have to figure out the next step alone. Houston Mind & Brain specializes in treatment-resistant depression, led by Dr. Raymond Cho, a psychiatrist with decades of NIH-funded research in neurostimulation.

Our psychiatric providers start with a full review of what you've already tried. We reserve an hour for your consultation, because depression that hasn't responded to treatment takes time to understand medically, psychologically and socially. From there, your plan can include TMS, Spravato, ketamine-assisted psychotherapy, medication management and therapy, all under one roof. Our clinical team typically reviews the progress of every TMS and ketamine patient each week.

Learn more about our depression treatment in Houston , see the insurance plans we accept , or request an appointment to talk through your options.

Contact Houston Mind & Brain

Frequently Asked Questions About Treatment-Resistance Depression

What do they do for treatment-resistant depression? Doctors usually start by reviewing what you've already tried, then adjust or add medications, or move to treatments that work differently, such as TMS, Spravato (esketamine) or ketamine-assisted psychotherapy. Many people do best with a combination. The options section above walks through each one.

What qualifies you for treatment-resistant depression? Most doctors and insurance plans consider depression treatment-resistant after at least two antidepressants haven't brought enough relief, each taken at an adequate dose for an adequate length of time. A careful review sometimes shows an earlier trial didn't count, which can change the next step.

How long does treatment-resistant depression last? There's no set timeline, and it isn't permanent: the label describes how you've responded to past treatment, not what happens next. Without a treatment that works, an episode can last months or years. With the right treatment, many people start to feel better within weeks. A TMS course runs for several weeks, and Spravato can work faster than oral antidepressants for some people.

What should you do when SSRIs don't work? Don't stop on your own, since stopping suddenly can cause withdrawal symptoms or a relapse. Talk with your prescriber. Common next steps include raising the dose, switching to a different type of antidepressant (such as an SNRI or bupropion), adding a second medication, or trying a treatment that works differently, like TMS or Spravato. If you've already tried two or more antidepressants, ask for an evaluation with a psychiatrist who specializes in treatment-resistant depression.

Does insurance cover treatment for treatment-resistant depression? Many plans cover TMS and Spravato for treatment-resistant depression when medical criteria are met. They usually require records of the antidepressants you've already tried.

Can I stay on my antidepressant during TMS or Spravato? Often, yes. Many people continue their medication during TMS, and Spravato can be used with or without an oral antidepressant. Your provider will decide what's right for you.

References

Rush AJ, Trivedi MH, Wisniewski SR, 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.
Zhdanava M, Pilon D, Ghelerter I, et al. The prevalence and national burden of treatment-resistant depression and major depressive disorder in the United States . Journal of Clinical Psychiatry. 2021.
McIntyre RS, Alsuwaidan M, Baune BT, et al. Treatment-resistant depression: definition, prevalence, detection, management, and investigational interventions . World Psychiatry. 2023;22(3):394–412.
Bousman CA, Stevenson JM, Ramsey LB, et al. Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for CYP2D6, CYP2C19, CYP2B6, SLC6A4, and HTR2A genotypes and serotonin reuptake inhibitor antidepressants . Clinical Pharmacology & Therapeutics. 2023;114(1):51–68.
Strawbridge R, Arnone D, Danese A, et al. Inflammation and clinical response to treatment in depression: a meta-analysis . European Neuropsychopharmacology. 2015.
Nanni V, Uher R, Danese A. Childhood maltreatment predicts unfavorable course of illness and treatment outcome in depression: a meta-analysis . American Journal of Psychiatry. 2012.
Carpenter LL, Janicak PG, Aaronson ST, et al. Transcranial magnetic stimulation (TMS) for major depression: a multisite, naturalistic, observational study of acute treatment outcomes in clinical practice . Depression and Anxiety. 2012.
Reif A, Bitter I, Buyze J, et al. Esketamine nasal spray versus quetiapine for treatment-resistant depression . New England Journal of Medicine. 2023.
Anand A, Mathew SJ, Sanacora G, et al. Ketamine versus ECT for nonpsychotic treatment-resistant major depression . New England Journal of Medicine. 2023.
Mohamed S, Johnson GR, Chen P, et al. Effect of antidepressant switching vs augmentation on remission among patients with major depressive disorder unresponsive to antidepressant treatment: the VAST-D randomized clinical trial . JAMA. 2017.
Fava M, Rush AJ, Alpert JE, et al. Difference in treatment outcome in outpatients with anxious versus nonanxious depression: a STAR*D report . American Journal of Psychiatry. 2008.
Johnson & Johnson. SPRAVATO (esketamine) approved in the U.S. as the first and only monotherapy for adults with treatment-resistant depression . January 21, 2025.
988 Suicide & Crisis Lifeline .

Learn more about Depression Treatment at Houston Mind & Brain →

Virtual depression treatment for Texas residents

See a psychiatrist from home. Your evaluation, treatment, and follow-up visits online.

How we treat Depression →

Available to patients located in Texas at the time of the visit.

Non-Stimulant ADHD Medication: What Adults Should Know in 2026

Sun, 20 Sep 2026 20:20:31 GMT

With the Adderall shortage still affecting patients nationwide, here's how Strattera, Qelbree, and other non-stimulant options compare — and who they're right for.

If you've spent the last few years calling pharmacy after pharmacy trying to fill an Adderall or Ritalin prescription, you're far from alone. A CDC survey published in late 2024 found that roughly 7 in 10 adults with ADHD who take a stimulant medication had trouble filling their prescription because of ongoing shortages — a crisis that started in October 2022 and, as of 2026, still hasn't fully resolved. For many patients, that disruption has made non-stimulant ADHD meds a serious option worth understanding, not just a fallback.

Why the Adderall Shortage Isn't Going Away Overnight

Stimulant ADHD medications — Adderall, Ritalin, Vyvanse, and their generics — are Schedule II controlled substances. That means the DEA sets a hard annual ceiling, called an Aggregate Production Quota, on how much of the active ingredient manufacturers are allowed to produce nationwide. When ADHD diagnoses and prescriptions climbed faster than those quotas did, a persistent supply gap opened up.

The DEA has raised quotas several times to try to close that gap — a roughly 25% increase to d-amphetamine production in October 2025, followed by 2026 quotas set about 14% above initial proposals after more than 5,000 public comments. Even with those increases, supply chain issues, manufacturing delays, and rising demand mean shortages of specific strengths and formulations are still being reported into 2026.

Non-stimulant medications aren't caught up in any of this. Atomoxetine, viloxazine, guanfacine, and clonidine are not controlled substances and aren't subject to DEA production quotas at all — supply has stayed stable throughout the entire stimulant shortage.

The Four FDA-Approved Non-Stimulant ADHD Meds

Only four non-stimulant medications currently carry FDA approval for ADHD, split into two mechanisms:

Norepinephrine reuptake inhibitors:

Atomoxetine (Strattera) — the original non-stimulant, FDA-approved in 2003. Still the most commonly prescribed, and available as an inexpensive generic. Clinical trials show a meaningful effect on core ADHD symptoms, though it typically takes 2-6 weeks to reach full benefit.
Viloxazine (Qelbree) — approved for children in 2021 and extended to adults in 2022. Works similarly to atomoxetine but may begin helping somewhat sooner — some pediatric trials showed a response within the first week. It's brand-only, so cost is usually higher than generic atomoxetine.

Alpha agonists:

Guanfacine ER (Intuniv) — often used alone or combined with a stimulant, particularly helpful for impulsivity and emotional reactivity.
Clonidine ER (Kapvay) — similar profile to guanfacine, sometimes preferred based on side-effect tolerance.

These four make up the FDA-approved non-stimulant ADHD medication category — there's no single "best" option, since the right choice depends on your symptoms, side-effect tolerance, and what else is going on with your health.

What About Wellbutrin? Understanding Off-Label Options

Bupropion (Wellbutrin) isn't one of the four FDA-approved non-stimulant medications listed above — it's an antidepressant that some providers, including ours, prescribe off-label for ADHD. "Off-label" means the medication wasn't originally studied and approved by the FDA specifically for ADHD, even though real clinical evidence and experience support its use in the right patients. It's not experimental or unusual — off-label prescribing is common and legal practice in psychiatry.

Bupropion affects dopamine and norepinephrine, which is part of why it can help with ADHD symptoms even without formal ADHD approval. It's often considered specifically for patients who:

Have ADHD alongside depression, since bupropion can address both at once
Haven't tolerated one of the four FDA-approved non-stimulants well
Want to avoid both controlled substances and the specific side-effect profile of atomoxetine or viloxazine

As with any off-label medication, the decision should be made with a provider who can walk you through why it fits your specific situation.

Strattera vs. Adderall: What's the real difference?

Adderall and other stimulants generally produce a stronger, faster effect for most patients — often within hours. Strattera takes weeks to build up but avoids the controlled-substance status, the shortage risk, and the abuse potential that comes with a Schedule II medication. Neither is universally "better" — it depends on your symptom severity, medical history, and whether shortage risk or fast onset matters more to you.

Qelbree vs. Strattera: How do they compare?

Both work through a similar mechanism, and no head-to-head trial has shown one is clearly more effective than the other. The practical differences come down to cost (Strattera has a cheap generic; Qelbree is brand-only), and onset (Qelbree may start working slightly faster for some patients). The choice usually comes down to insurance coverage and how your body responds to each, not a clear efficacy edge.

Who Tends to Do Well on a Non-Stimulant

Non-stimulant ADHD meds aren't typically a provider's first choice when a patient has straightforward ADHD and no other complicating factors — stimulants generally work more strongly for most people. But they're often the right choice, not just a backup, for:

Patients with a history of substance use — non-stimulants carry essentially no abuse potential, since they're not controlled substances
Patients with anxiety alongside ADHD — stimulants can sometimes worsen anxiety symptoms; non-stimulants avoid that activation
Patients with certain cardiac risk factors , where a stimulant's effect on heart rate and blood pressure is a bigger concern
Patients who've been repeatedly unable to fill a stimulant prescription and need reliable, consistent access
Patients who simply prefer to avoid a controlled substance , for personal or professional reasons

Do Non-Stimulant ADHD Meds Actually Work?

Yes, for most patients — though differently than stimulants. Non-stimulants build up gradually rather than acting immediately: most patients notice some improvement within 2-4 weeks, with full benefit sometimes taking 6-8 weeks. This is worth planning for — a non-stimulant isn't the right choice if you need symptom relief immediately, but it's often a better long-term fit once it's had time to work.

Common side effects differ by type: atomoxetine and viloxazine can cause nausea, appetite changes, and a modest increase in heart rate or blood pressure; guanfacine and clonidine tend to cause drowsiness and can lower blood pressure. None of the four require the kind of careful controlled-substance monitoring that stimulants do, though your provider will still want to check in during the first few weeks.

Common Questions About Non-Stimulant ADHD Medication

Are non-stimulant ADHD medications addictive?

No. None of the four FDA-approved non-stimulant ADHD meds — atomoxetine, viloxazine, guanfacine, or clonidine — are controlled substances, and none carry meaningful abuse or addiction potential. That's a key reason they're often preferred for patients with a history of substance use.

Can you take a stimulant and a non-stimulant ADHD medication together?

Yes, this is common. Guanfacine ER and clonidine ER in particular are frequently prescribed alongside a stimulant to address symptoms — like emotional reactivity or impulsivity — that the stimulant alone doesn't fully cover. Your provider can determine whether combination treatment makes sense for you.

Does non-stimulant ADHD medication suppress appetite?

It can, but usually less than stimulants. Atomoxetine and viloxazine may cause some appetite reduction, especially early on; guanfacine and clonidine typically don't affect appetite at all.

How HMB Approaches ADHD Treatment

Given how disruptive the stimulant shortage has been — and how cautious the DEA has become around Schedule II prescribing generally — our psychiatric providers take a deliberately careful approach to ADHD diagnosis and treatment. We don't diagnose ADHD on a first visit. Instead, our process includes a full evaluation, collateral information from people who know you well, and follow-up cognitive testing to confirm what's actually going on before any medication — stimulant or non-stimulant — is prescribed.

One clarification that matters here: this isn't the same as the long, expensive, hours-long comprehensive neuropsychological testing some patients expect (often needed for school or workplace accommodation requests). We don't offer that specific type of testing — our evaluation process is focused on accurate diagnosis and safe, appropriate treatment, not accommodation documentation.

If you've been struggling with the stimulant shortage, dealing with side effects, or simply want to understand whether a non-stimulant medication makes sense for you, our team can walk you through the options as part of a full evaluation.

Learn more about ADHD Treatment at Houston Mind & Brain →

Virtual ADHD treatment for Texas residents

See a psychiatrist from home. Your evaluation, treatment, and follow-up visits online.

How we treat ADHD →

Available to patients located in Texas at the time of the visit.

How to Choose a Psychiatrist in Houston: What to Look For

Wed, 02 Sep 2026 19:07:24 GMT

Psychiatry in Houston: A Complete Guide to Finding the Right Care

If you're searching for a psychiatrist in Houston , you're probably somewhere between "something isn't working" and "I don't know what kind of help I actually need." That's a normal place to start. Psychiatry can mean a lot of different things depending on the practice — a quick medication check, a full diagnostic evaluation, or a coordinated plan that includes therapy and advanced treatments. This guide walks through what psychiatric care in Houston actually looks like, what to check for in a provider, and when it might be time to consider options beyond standard treatment.

What Does a Psychiatrist Actually Do?

A psychiatrist is a medical doctor (MD or DO) who specializes in diagnosing and treating mental health conditions. Unlike a therapist or counselor, a psychiatrist can prescribe and manage medication, order or interpret medical testing related to mental health, and oversee more advanced interventions like TMS or Spravato (esketamine) .

Many people benefit from both — a psychiatrist for diagnosis and medication management, and a therapist for ongoing talk therapy. Some Houston practices, including ours, offer psychotherapy alongside psychiatric care so both pieces are coordinated under one team instead of split across separate offices that don't talk to each other.

What to Look for in a Houston Psychiatrist

Not all psychiatric care is structured the same way. A few things worth checking before you book an evaluation:

Physician oversight. Is a board-certified psychiatrist actually involved in your care plan, or are you seeing a nurse practitioner with no physician review of complex cases?
A real diagnostic evaluation. A thorough first visit should look at your full history, not just symptoms in isolation — this is what shapes an accurate treatment plan instead of a guess-and-check approach to medication.
A path beyond medication alone. Standard medication and therapy help most people, but not everyone. It's worth knowing upfront whether a practice has options if first-line treatment doesn't fully work.
Insurance transparency. Ask whether the practice verifies your benefits and gives you a written estimate before treatment starts, so there are no surprises later.

When Standard Treatment Isn't Enough

For a significant number of people, first-line antidepressants or standard therapy don't fully resolve depression, OCD, or anxiety. If that's been your experience, it doesn't mean you've run out of options — it usually means it's time to talk to a psychiatrist who offers more than medication management alone. In Houston, a growing number of practices — including Houston Mind & Brain — offer FDA-cleared advanced treatments for exactly this situation:

TMS (Transcranial Magnetic Stimulation) — a non-invasive, non-drug treatment that uses magnetic pulses to target the brain circuits involved in depression and OCD. No sedation, no downtime — most patients drive themselves home and return to normal activities the same day.
Spravato (esketamine) — an FDA-approved nasal treatment for treatment-resistant depression, administered in-clinic with monitoring.
Ketamine-Assisted Psychotherapy — supervised ketamine dosing paired with focused therapy sessions to help translate rapid symptom relief into lasting change.

These aren't "last resort" treatments — they're appropriate any time standard care hasn't gotten someone where they need to be, and earlier access generally means a faster path to relief.

What to Expect at Your First Visit

A first psychiatric evaluation in Houston typically includes a review of your symptoms, treatment history, and relevant medical background, followed by a discussion of options — which might be medication, therapy, a combination, or a referral for advanced treatment if standard approaches have already been tried. A good practice will explain the reasoning behind the plan, not just hand you a prescription. If you're unsure where to start, a short introductory call with a specialist before committing to a full evaluation can help clarify next steps.

Conditions Psychiatrists in Houston Commonly Treat

Psychiatric care covers a wide range of conditions, including:

Depression, including treatment-resistant depression
OCD (obsessive-compulsive disorder)
Bipolar disorder
Anxiety disorders
ADHD
TBI-related psychiatric symptoms

If you've been treated for one of these conditions before without lasting relief, that history is useful information for a new psychiatrist — it helps rule out what hasn't worked and narrow in on what might.

Insurance and Cost

Most Houston psychiatry practices work with major insurance plans, though coverage for advanced treatments like TMS or Spravato depends on your plan and whether medical-necessity criteria are met. A practice that checks your benefits and gives you a written estimate before treatment begins can save you from unexpected bills later — it's worth asking about this directly during your first call.

About This Guide

This guide was written by the clinical team at Houston Mind & Brain , a physician-led psychiatry practice in Houston founded by Dr. Raymond Cho , MD, M.Sc. (Neuroscience). Dr. Cho trained at the University of Toronto and the University of Pittsburgh, has held a faculty appointment at Baylor College of Medicine, and spent over two decades in NIH-funded research on neurostimulation and brain-based treatment before founding TMS programs at Baylor, UTHealth, and the VA.

Frequently Asked Questions

What's the difference between a psychiatrist and a therapist? A psychiatrist is a medical doctor who can diagnose conditions, prescribe medication, and oversee treatments like TMS or Spravato. A therapist provides talk therapy but cannot prescribe medication. Many patients see both, ideally coordinated as part of one plan.

How do I know if I need to see a psychiatrist? If you've tried therapy or medication through a primary care provider and still aren't seeing the improvement you'd expect, or if your symptoms are significantly affecting daily life, a psychiatric evaluation can help identify what's actually going on and what treatment fits.

Is psychiatric care in Houston covered by insurance? Most practices accept major commercial insurance, and many plans cover standard psychiatric visits and medication management. Coverage for TMS and Spravato varies by plan — ask any practice you're considering to verify your specific benefits before you start.

What if medication hasn't worked for me? That's one of the most common reasons people seek out a new psychiatrist. Treatment-resistant depression and OCD are exactly what options like TMS, Spravato, and ketamine-assisted psychotherapy are designed for.

Looking for a psychiatrist in Houston?

Houston Mind & Brain offers evaluation-based psychiatric care, including medication management, therapy, TMS, Spravato, and ketamine-based treatment — all under one roof.