Treatment-Resistant
Protocols
Augmentation strategies and rare medication combinations for patients who haven't responded to standard first-line approaches. Dr. Farkas's NIH research training and pharmaceutical background make her uniquely capable of navigating this terrain.
How Dr. Farkas approaches
Protocols
Evidence-based, neurobiologically-informed. Every prescribing decision is grounded in mechanism — not tradition or trial-and-error.
From evaluation to
lasting results
Treatment-Resistant Protocols is used to treat
these conditions
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What to expect at
your first appointment
New patient evaluations are 30–60 minutes — never a rushed intake. Dr. Farkas takes your full psychiatric, medical, and medication history before making any prescribing decisions. You'll leave with a clear diagnosis, a treatment plan that makes sense to you, and a follow-up already scheduled.
Telehealth available throughout South Carolina and New York. In-person at our Hilton Head Island, SC office.
Ready for prescribing done
at the MD/PhD level?
30–60 minutes. Expert diagnosis. A treatment plan built around your specific neurobiology and goals.
Treatment-resistant psychopharmacology applies systematic algorithms for depression, anxiety, OCD, bipolar, and psychosis that haven't responded to first-line care. Steps include diagnostic reconsideration, adequate dose/duration verification, strategic augmentation (lithium, thyroid, atypical antipsychotics), combination therapy, and referral for advanced interventions (esketamine, TMS, ECT).
Key Takeaways
- Treatment-resistant protocols apply when depression, anxiety, OCD, bipolar disorder, or psychosis hasn't responded to first-line care.
- What counts as resistant differs by condition, and adequate dose and duration are checked first.
- Add-on strategies are chosen by condition, such as lithium or thyroid hormone for depression.
- Advanced options include esketamine, TMS, and ECT, through referral where indicated.
Frequently Asked Questions
What defines treatment resistance?
Definitions vary by condition. Treatment-resistant depression is generally two adequate antidepressant trials without adequate response. Treatment-resistant OCD is two adequate SSRI trials plus a clomipramine trial. Treatment-resistant schizophrenia is two adequate antipsychotic trials. 'Adequate' includes both dose and duration.
What augmentation works best?
For depression: lithium, thyroid hormone, atypical antipsychotics (aripiprazole, quetiapine, brexpiprazole, cariprazine). For OCD: aripiprazole, risperidone, memantine. For anxiety: buspirone, atypical antipsychotics. Selection is individualized.
When are advanced interventions considered?
Esketamine (Spravato) is FDA-approved for treatment-resistant depression and can produce rapid response. TMS is FDA-approved for depression and OCD. ECT remains highly effective for severe treatment-resistant depression and bipolar depression. Dr. Farkas refers to specialized centers where indicated.
Related pages
Call or text 988 (Suicide & Crisis Lifeline). Text HOME to 741741 for the Crisis Text Line. Call 911 or go to your nearest emergency room if you are in immediate danger.