Condition · Texas
Treatment-Resistant Depression Care in Texas
Depression is called treatment-resistant when two antidepressants at an adequate dose and duration have not produced meaningful improvement. The next step is a full diagnostic re-review, not another quick switch. Lyte Psychiatry reassesses the diagnosis, the dosing history, and what has been missed.
Clinically reviewed by Dr. Akinwande Akintola, MD · Last reviewed July 2026 · Next review January 2027
Understanding treatment-resistant depression
The word resistant describes the treatment history, not the person. Before anything is added, the more useful question is whether each previous trial was actually adequate: the right diagnosis, a therapeutic dose, six to eight weeks at that dose, and taken consistently.
Re-evaluation frequently changes the picture. Undetected bipolar spectrum illness, ongoing trauma symptoms, thyroid disease, sleep apnoea, alcohol use, and untreated ADHD all blunt antidepressant response, and each one is treated differently from a simple medication switch.
When outpatient options are genuinely exhausted, the honest answer is referral. Lyte does not deliver TMS, esketamine, or ECT, and we say so before you spend another six months waiting for a plan that cannot get there.
Symptoms and when to seek an evaluation
- Persistent depressive symptoms after two or more medication trials
- Partial response that never reaches remission
- Repeated relapse each time a medication is tapered
- Growing hopelessness specifically about treatment itself
- Side-effect burden that has made further trials feel not worth it
Seek an evaluation when these symptoms have lasted for weeks, are getting worse, or are affecting your work, sleep, or relationships. If you are thinking about harming yourself, call or text 988 now.
What your first visit involves
- Structured medication history: agent, maximum dose reached, weeks at that dose, and reason for stopping
- Re-screening for bipolar spectrum illness, trauma, ADHD, and substance use
- Medical contributors, including thyroid function, anaemia, sleep-disordered breathing, and chronic pain
- Adherence and tolerability review, because most inadequate trials stopped early for a reason worth naming
First appointments run longer than follow-ups so there is time to take a full history. You leave with a working diagnosis, a plan, and a follow-up date rather than a prescription and no explanation.
Therapy, psychiatry, and combined care
- Diagnostic re-formulation before any new prescription
- Optimising an existing medication to a full therapeutic dose and duration
- Switching class or adding an evidence-based augmentation agent where appropriate
- Adding structured psychotherapy when previous care was medication-only
- Referral to interventional psychiatry when outpatient pharmacotherapy has been exhausted
Therapy and psychiatry are delivered in-house by clinicians licensed in Texas and share one chart, so a prescriber and a therapist working with you are looking at the same notes. Many people do best with both.
What we do not treat here
- Lyte does not provide TMS, esketamine, ketamine infusion, or ECT
- We do not offer inpatient or partial-hospitalisation level care
- Genetic testing is not used at Lyte to select antidepressants
Care options at Lyte
Clinicians who provide this care
Insurance and cost
Lyte is in network with several Texas plans, and coverage depends on your specific plan and benefits. We verify your benefits before the first visit so you know your expected cost in advance. See which plans we accept.
Frequently asked questions
What actually counts as a failed antidepressant trial?
An adequate trial means a therapeutic dose, taken consistently, for roughly six to eight weeks. Two weeks at a starting dose that was stopped because of nausea is not a failed trial, and treating it as one leads to unnecessary escalation.
Does Lyte provide TMS or ketamine?
No. Lyte is an outpatient psychiatry and therapy practice. When interventional treatment is indicated, we tell you directly and coordinate referral rather than keeping you in a plan that cannot deliver it.
Is treatment-resistant depression a permanent diagnosis?
No. It describes the response to date. A meaningful share of people labelled resistant improve once the diagnosis is corrected, a medication is finally dosed adequately, or a missed contributor such as sleep apnoea or alcohol use is treated.
What should I bring to a re-evaluation visit?
A list of every psychiatric medication you have taken, the highest dose you reached, roughly how long you stayed on it, and why it stopped. That single list changes the plan more often than any other piece of information.
Sources
Related conditions
- Depression: a first depressive episodeMost people never reach the resistant category; the standard pathway is covered on the main depression page.
- Bipolar Disorder: unrecognised bipolar illnessAntidepressant non-response is one of the classic signals that the underlying diagnosis is bipolar rather than unipolar.
- Persistent Depressive Disorder: chronic low-grade depressionLong-duration low mood can look like resistance when it is really an untreated chronic course.
- Complex PTSD: trauma that keeps depression in placeUnaddressed trauma symptoms are a common reason depression treatment plateaus.
This page is for general education and is not medical advice or a substitute for care from your own clinician. If you are in crisis, call or text 988 (the Suicide & Crisis Lifeline), and for a medical emergency call 911.
Book a comprehensive re-evaluation with a Lyte prescriber
Lyte Psychiatry sees patients by secure telehealth across Texas and in person at our Pantego clinic in the Dallas–Fort Worth area.
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