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When Traditional Treatments Don’t Work: A Guide to Treatment-Resistant Depression (TRD)

For those living with treatment-resistant depression, it’s common to feel like you’ve tried everything — multiple medications, therapy, lifestyle changes — and still, the cloud won’t lift. At Blue Umbrella Psychiatry, we offer Spravato® (esketamine) as a powerful, FDA-approved treatment option when standard antidepressants haven’t provided relief. Spravato isn’t a first-line treatment — it’s for patients who have tried at least two other antidepressants without success. But for the right individuals, it can be life-changing. What Is Spravato®? Spravato® is a nasal spray form of esketamine, a medication derived from ketamine. Unlike traditional antidepressants that target serotonin or norepinephrine, esketamine acts on glutamate — a different brain chemical involved in mood regulation and neuroplasticity (the brain's ability to form new connections). Because of this unique mechanism, many patients begin to feel improvement within hours to days — not weeks. Who Is It For? Spravato® is approved for adults with: Treatment-resistant depression Major depressive disorder with suicidal thoughts or behaviors It’s typically used in combination with an oral antidepressant for best results. What to Expect During Treatment Spravato® must be administered in-office under supervision due to its potential side effects. At Blue Umbrella Psychiatry, our Breakthrough Center offers a calm, private treatment space designed for your safety and comfort. Here’s how it works: You self-administer the nasal spray in our clinic. You remain under observation for two hours afterward. Our staff monitors your blood pressure, vital signs, and response. You’ll need a ride home after each session. Starting Strong: Twice a Week for Four Weeks To maximize effectiveness, patients begin Spravato® treatment with an induction phase — typically twice-weekly sessions for the first four weeks. This schedule is designed to give your brain the best chance to respond and stabilize. After that, treatment usually shifts to once weekly or every other week, based on your progress and your provider’s recommendation. Is Spravato® Safe? Spravato® is well-studied and FDA-approved, but it isn’t right for everyone. Common side effects can include dizziness, dissociation, nausea, or increased blood pressure. That’s why it’s administered in a structured, supervised setting. Before starting, you’ll undergo a comprehensive evaluation to ensure it’s a safe and appropriate fit for your needs. Real Relief, Backed by Science Many of our patients who have felt stuck or hopeless with other medications report that Spravato® finally offers a shift — a sense of lightness, clarity, or energy they haven’t felt in years. Some say it’s the first treatment that made a noticeable difference. It’s not a magic fix, but it’s a significant step forward when other paths have been exhausted. Spravato® + Therapy: A Healing Combination At Blue Umbrella Psychiatry, we believe Spravato® is most powerful when paired with therapy. Medication can lift the fog — therapy helps you rebuild once you can see the road again.  Our therapists work closely with psychiatric providers to support your healing, offering a whole-person approach to recovery. Is Spravato® Right for You? Let’s Talk If you’re feeling stuck and nothing else has helped, Spravato® may be worth exploring. You don’t have to go it alone — and you don’t have to keep trying the same things expecting different results.

When we think of depression, we often picture someone who can’t get out of bed, who cries constantly, or who’s visibly struggling. But depression doesn’t always look like what we expect. Many adults live with high-functioning depression — managing careers, parenting, and responsibilities on the outside, while quietly battling pain on the inside. At Blue Umbrella Psychiatry, we frequently see individuals who “have it all together” but feel empty, exhausted, or numb underneath. If this sounds like you or someone you love, you’re not alone — and there are ways to find balance, relief, and renewed purpose. What Is High-Functioning Depression? High-functioning depression isn’t a clinical diagnosis on its own — it often refers to Persistent Depressive Disorder (dysthymia) or Major Depressive Disorder that’s masked by productivity. People with high-functioning depression may keep up appearances, perform well at work, and fulfill social roles — all while feeling internally depleted. Common signs include: Constant low mood or emptiness Feeling tired or emotionally flat, even with enough sleep Difficulty enjoying things you used to love Irritability, guilt, or self-criticism Overworking or perfectionism to distract from inner distress Withdrawing emotionally, even while staying socially active “Everything is fine” on the outside, but “I’m not okay” inside This form of depression is especially tricky — because it can go unnoticed, even by the person experiencing it. Why It Often Gets Missed High-functioning adults are often praised for being dependable, driven, and strong. This can lead to pressure to hide vulnerability, push through symptoms, or dismiss your own suffering. You might tell yourself: "Other people have it worse." "I should be grateful." "I just need to work harder." But depression doesn’t care how successful you are or how busy your calendar is. If you’re feeling emotionally numb, disconnected, or constantly overwhelmed, it’s worth paying attention. The Impact of Ignoring High-Functioning Depression When untreated, high-functioning depression can gradually erode your quality of life. Over time, it can lead to: Burnout and chronic fatigue Relationship strain Poor concentration and memory Increased risk for anxiety or substance use Loss of meaning or joy Worse, people often delay seeking help because they don’t “look depressed.” That’s why compassionate, early support matters. How We Help at Blue Umbrella Psychiatry You don’t have to wait for a crisis to seek help. At Blue Umbrella Psychiatry, we provide psychiatric evaluations and personalized treatment plans for adults dealing with all types of depression — including the quiet kind. Our approach includes: Medication management, when appropriate, to restore mood stability Therapy to address emotional burnout, perfectionism, and core beliefs Lifestyle support, including sleep, nutrition, and stress reduction strategies Ongoing collaboration between psychiatry and therapy to ensure continuity of care We aim to create a space where you don’t have to pretend everything is fine — because healing starts with honesty and support. You're Not Broken — You're Human High-functioning depression is not a character flaw. It’s a real mental health condition that deserves real care. You’re allowed to have struggles, even if everything “looks fine.” You’re allowed to ask for help, even if others rely on you.  Therapy and psychiatric support can help you reconnect with your feelings, rediscover joy, and manage your mental health in sustainable ways. Let’s Talk — You Don’t Have to Do It Alone If you’ve been carrying quiet sadness, chronic fatigue, or emotional numbness, we see you — and we’re here to help. At Blue Umbrella Psychiatry, our team offers compassionate, integrated care that goes beyond the diagnosis. Together, we’ll explore what you’re going through and create a plan that fits your life — so you can feel more like yourself again.