Treating Treatment-Resistant Depression: Jane’s Story

Jane is a 49-year-old woman who had lived with depression for more than two decades. Despite years of therapy and multiple medications, she found little or no relief. She battled chronic worry, insomnia, guilt, and a deep sense of hopelessness.

Jane grew up in a chaotic household with an alcoholic father and a mother who also struggled with depression. She became the caretaker for her siblings at a young age, which taught her to prioritize others over herself. As an adult, she carried these patterns forward. She raised her children, supported her grandchildren, and cared for her aging parents, all while working as a cashier in a job that paid the bills but did not bring fulfillment. By the time she came to LifeStance, her depression symptoms were significant and unrelenting.

Jane was first diagnosed with major depressive disorder (MDD) at age 25. Over the years, she tried many different antidepressants, sometimes in combination, but each trial either failed to bring relief or left her with difficult side effects. Like many people with treatment-resistant depression, she had been through the most common medication categories, including selective serotonin reuptake inhibitors (SSRIs), serotonin and noradrenaline reuptake inhibitors (SNRIs), and other antidepressants that are typically used before TRD is recognized.

Despite all of these attempts, Jane continued to struggle with significant symptoms. By the time she came to LifeStance, her PHQ-9 score was 16, which reflects moderately severe depression. The PHQ-9 is a standard questionnaire used by clinicians to measure the severity of depression symptoms. Scores range from 0 to 27, with higher numbers showing more severe depression.

Even after two months of therapy, her score remained nearly unchanged at 15. This supported the clinical assessment that Jane was experiencing treatment-resistant depression, and that she needed a new approach beyond traditional medications.

At LifeStance, we carefully re-evaluated Jane’s case. We looked again at her history, her symptoms, and what had already been tried.

When traditional antidepressants and years of talk therapy no longer bring relief, it is important to look at newer and more innovative treatments. Jane’s care team discussed several novel options that are FDA-approved for people with TRD:

• Transcranial Magnetic Stimulation (TMS): A non-invasive treatment that uses magnetic pulses to stimulate underactive areas of the brain involved in mood regulation. TMS is done in-office, is generally well-tolerated, and has few side effects for many people.
• Spravato® (esketamine nasal spray): A rapid-acting antidepressant treatment given in a certified clinic under supervision. Many people have reported improvements within hours or days.
• Electroconvulsive Therapy (ECT): A long-standing treatment for severe depression that is delivered under anesthesia. While highly effective for some individuals, others may decline because it carries risks of memory issues and often involves a prolonged recovery that may be disruptive to their daily routine.

After reviewing these options, Jane was most interested in TMS because it did not involve adding more medications and offered a non-invasive way forward. Together with her LifeStance team, she decided this was the right next step in her journey.

Jane began a six-week course of daily TMS sessions. The treatment used gentle magnetic pulses to stimulate underactive areas of her brain linked to mood regulation. At first, she was skeptical, but within a few weeks she noticed subtle changes. Her sleep improved, and she began to feel more energy.

As treatment progressed, her symptoms continued to improve. She described her mindset shifting from hopelessness to thankfulness. Combined with ongoing therapy to help her build resilience and address her trauma history, TMS helped Jane feel engaged with life again.

Jane shared, “TMS has made a meaningful difference for me when nothing else worked. From therapy to the TMS treatments, this experience has significantly improved my life.”

Jane’s case shows us that depression, even when more severe and long-lasting, is not hopeless. Treatment-resistant depression can require persistence, careful re-evaluation, and sometimes innovative approaches like TMS or Spravato. By combining therapies and working as a multidisciplinary team, we can help individuals find relief even after years of struggle.

If you or someone you love has struggled with depression that has not improved after multiple treatments, know that you are not alone. At LifeStance, our team is committed to helping people like Jane find renewed hope and relief.

Schedule an appointment today to learn more about treatment options for depression, including TMS and Spravato, and see if these therapies may be right for you.

Individual results vary, and outcomes are not guaranteed. Treatment options are offered only when clinically appropriate and under the supervision of a qualified mental health provider.