★ Specialty Focus

Treatment-Resistant
Depression

Sophisticated augmentation when first-line care has failed. Dr. Farkas's MD/PhD neuroscience training enables strategic, mechanistically-informed treatment for patients who have not responded to standard antidepressant therapy.

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Failed antidepressants = TRD

MD/PhD

Neuroscience expertise

NIH

Research center trained

3 States

SC · NY · VA telehealth

When to consider Dr. Farkas for TRD

Tried 2+ antidepressants without adequate relief

Diagnosed with depression but symptoms don't improve

Partial response — some improvement but not enough

Intolerable side effects from previous medications

Considering TMS or ketamine therapy

Want expert second opinion before next medication trial

Understanding TRD

Why standard treatment
sometimes fails

Treatment-resistant depression (TRD) is typically defined as depression that has not responded adequately to at least two antidepressant medications at therapeutic doses and duration. It affects roughly one-third of people with major depression — and it's exactly what Dr. Farkas built her practice to address.

The key insight from Dr. Farkas's neuroscience background: when three SSRIs have all failed, that pattern is meaningful data. SSRIs all work through the same neurobiological mechanism. If that mechanism worked, one of them would have. This tells you something important about the next step — and standard psychiatry often misses it.

TRD frequently has underlying causes that were never properly investigated: a bipolar disorder misdiagnosed as unipolar depression, a contributing medical condition (thyroid, B12, hormonal), or a pharmacological mismatch identifiable through genetic testing.

Learn more at NIMH: Depression ↗

Dr. Farkas's diagnostic lens for TRD

Was the diagnosis correct? Bipolar disorder misdiagnosed as depression requires a completely different treatment approach.

Medical contributors? Thyroid dysfunction, vitamin B12 deficiency, hormonal imbalances, and neurological conditions can all cause or worsen depression.

Right pharmacological target? Not all depression responds to serotonin. Norepinephrine, dopamine, glutamate pathways may be more relevant.

Pharmacogenomics? Genetic variations affect how you metabolize specific medications — testing can identify poor responders before another failed trial.

Treatment Approach

A systematic, neurobiologically-
informed strategy

Dr. Farkas doesn't try another antidepressant and hope for different results. She identifies why previous treatments failed — then chooses the next step strategically.

Step 01

🔍

Comprehensive Re-Evaluation

Full psychiatric re-assessment reviewing all prior diagnoses, medication trials, doses, and durations. Medical workup to rule out contributing conditions. Pharmacogenomic testing when appropriate.

Step 02

🧬

Mechanistic Strategy

Selection of next treatment based on neurobiological mechanism — not alphabetical order. If serotonergic approaches failed, explore noradrenergic, dopaminergic, or glutamatergic targets.

Step 03

⚗️

Augmentation Strategies

Addition of complementary agents — lithium, atypical antipsychotics, thyroid hormone, stimulants — to potentiate partial antidepressant response based on mechanism of action.

Step 04

⚡

Advanced Interventions

TMS therapy and ketamine-assisted treatment for patients where medication trials have been insufficient. Dr. Farkas manages the full clinical pathway for both.

Step 05

📊

Objective Outcome Tracking

PHQ-9 and other standardized measures at every visit. Objective data — not subjective impression — guides every treatment adjustment.

Step 06

🔄

Continuous Optimization

TRD rarely resolves with one adjustment. Dr. Farkas maintains close follow-up, adjusting the strategy systematically until meaningful, sustained improvement is achieved.

Advanced Interventions

When medication alone
isn't enough

For patients who haven't responded to multiple medication trials, Dr. Farkas offers the full toolkit of advanced psychiatric interventions.

⚡

✓ FDA-Cleared

TMS Therapy

Transcranial Magnetic Stimulation uses targeted magnetic pulses to stimulate specific brain circuits involved in mood regulation. Non-invasive, no anesthesia, no systemic side effects.

FDA-cleared for major depressive disorder

~50–60% response rate in TRD patients

20–40 minute outpatient sessions, 4–6 week course

No weight gain, sexual side effects, or cognitive effects

Covered by many insurance plans after medication failure

TMS Society research ↗

🔬

Emerging Evidence

Ketamine-Assisted Treatment

Rapid-acting relief via the glutamate/NMDA pathway — a completely different mechanism than SSRIs. Often provides meaningful relief within 24–72 hours when standard approaches have failed.

Rapid onset — often 24–72 hours to initial relief

Targets NMDA receptor system (different from SSRIs)

Effective for TRD, PTSD, and severe anxiety

Full pathway: evaluation, preparation, infusion, integration

NIMH research on ketamine ↗

Getting Started

What to expect from
your first appointment

A TRD evaluation with Dr. Farkas is 60–90 minutes. It's not a rushed 15-minute intake. It's a thorough, systematic re-assessment designed to find what previous treatments missed.

Come prepared to discuss your full history: every medication tried, at what dose, for how long, what improved (if anything), and what side effects occurred. Prior records are helpful but not required.

Complete review of all prior medication trials and treatment history

Investigation of medical contributors (thyroid, B12, hormonal)

Re-evaluation of prior diagnoses — including bipolar spectrum

Discussion of pharmacogenomic testing when appropriate

Clear explanation of findings and proposed treatment direction

Collaborative decision-making on next steps

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Other Services

🧠

General Adult Psychiatry

👴

Geriatric Psychiatry