If you've tried medication after medication and still feel the weight of depression, please hear this: it's not because you didn't try hard enough. Some depression needs a different kind of treatment, and there are proven options that work when antidepressants haven't.
Treatment-resistant depression (TRD) is the clinical term for major depressive disorder that hasn't improved enough after two or more antidepressants, each tried at a proper dose and for a proper length of time. It's a recognized and well-studied pattern in psychiatry, affecting roughly a third of people with depression at some point. It is not a measure of your effort or your character.
The reason this matters is practical. When standard antidepressants haven't worked, the answer usually isn't a fourth or fifth medication in the same class. It's a treatment that works on the brain through a different mechanism. That's exactly where treatments like TMS, Spravato, and IV ketamine come in, and it's the kind of care Better Balance Psychiatry was built to provide.
If several of these feel familiar, an evaluation for advanced options may be worthwhile.
These treatments work on the brain differently than standard antidepressants. Your psychiatrist will help you choose the right one.
Non-invasive magnetic stimulation of the brain's mood-regulating regions. FDA-cleared, no medication, covered by most major plans.
Explore TMS →An FDA-approved nasal spray for treatment-resistant depression, given under supervision and covered by most major plans.
Explore Spravato →Fast-acting infusions for depression that hasn't responded to other treatments, with relief often felt within days.
Explore IV Ketamine →A careful, systematic medication strategy overseen by a board-certified psychiatrist.
Explore Medication Management →Your treatment plan is directed by a board-certified psychiatrist, so your care is grounded in medical training, not a one-size-fits-all protocol.
The region voted us Best Psychiatrist in 2023, a reflection of the trust patients and families place in our team.
Therapy, medication, and advanced treatments under one roof in St. George and Cedar City, plus telehealth across Utah.
Dr. Hendleman founded Better Balance Psychiatry to bring advanced, evidence-based care to southern Utah. He specializes in treatment-resistant depression, trauma in uniformed service members, and advanced treatments including TMS, Spravato, and IV ketamine.
Learn MoreTreatment-resistant depression (TRD) is major depressive disorder that hasn't improved enough after two or more antidepressants tried at an adequate dose and duration. It's a recognized clinical pattern, not a personal failure, and it often responds to advanced treatments such as TMS, Spravato, or IV ketamine.
Not everyone's depression responds to the serotonin-based approach antidepressants use. Differences in brain biology, diagnosis, and dosing can all play a role. When medication alone hasn't been enough, treatments that work through different mechanisms are often the logical next step.
We treat TRD with TMS therapy, Spravato (esketamine), IV ketamine, and careful medication management. A board-certified psychiatrist recommends the approach with the strongest evidence for your situation.
No. The diagnosis describes what hasn't worked so far, not what's possible. Many people who didn't respond to medication improve significantly with advanced treatments.
No referral is required. You can contact us directly for an evaluation in St. George, Cedar City, or by telehealth across Utah.
Schedule a confidential consultation with our psychiatric team. We'll review everything you've already tried and build a plan around what comes next. No referral required.
In-person care in St. George and Cedar City · Telehealth across Utah
