Treatment-Resistant Depression Treatment
- Louisville, KY
FDA-cleared Deep TMS, 6-day Accelerated TMS, and Spravato for adults who have tried antidepressants without relief.
Triple-Board Certified, Expert Care
In-Network with Major Insurance Carriers
FDA-Cleared, Evidence-Based Treatments
Coordinated Care
What is Treatment-Resistant Depression?
Treatment-resistant depression (TRD) is major depressive disorder that has not responded adequately to at least two trials of antidepressant medication at adequate dose and duration. According to the American Psychiatric Association, 30-40% of adults with major depression do not achieve full remission with standard antidepressants.
TRD is not a sign that treatment cannot work. It is a signal that a different kind of care is needed. Interventional psychiatry (Standard Deep TMS and Spravato) was developed specifically for this situation.
How we treat treatment-resistant depression
Three evidence-based options. The right fit depends on your medication history, timeline, and insurance.
Standard TMS & Accelerated TMS
FDA-cleared non-invasive brain stimulation using the BrainsWay H1 coil, in two protocols. Standard TMS - 36 sessions over 12 weeks or SWIFT Accelerated treatment in 6 days using five 10-minute sessions per day. The only Louisville clinic offering the SWIFT protocol.
Learn more about Standard TMS
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Spravato (esketamine)
Spravato (esketamine) — FDA-approved rapid-acting nasal spray, administered under medical supervision in our REMS-certified clinic. Works through a different brain pathway than oral antidepressants.
Medication Management
Medication optimization — When TRD responds to a strategy that has not been tried: augmentation, newer agents, or dose adjustments. Can be combined with Deep TMS or Spravato.
Do I qualify for treatment-resistant depression care at Bluegrass Advanced Mental Health?
You are likely a candidate if:
- You are 18 or older (15 and older for Deep TMS)
- You have been diagnosed with major depressive disorder
- You have tried at least two antidepressants without adequate relief
- You are medically stable and not in a severe psychiatric crisis
- You have insurance (most commercial plans cover interventional psychiatry) or can arrange self-pay
The fastest way to find out: a free 5-minute screening call with our Patient Care team. We verify your insurance, confirm clinical criteria, and schedule your first appointment. No obligation.
What to expect
Your first visit is a 60-90 minute evaluation with Dr. Roth or a clinical team member. We review your full psychiatric history, prior treatments, and current symptoms. By the end you have a treatment recommendation, a timeline, and an insurance estimate.
Treatment length depends on the option that fits best:
- Standard Deep TMS: 36 sessions over 12 weeks (daily for 4 weeks, then twice weekly for 8 weeks)
- Accelerated TMS (SWIFT): 6 treatment days within 2 weeks, then 8 continuation sessions over 4 weeks
- Spravato induction: Twice weekly for 4 weeks, each visit approximately 2.5 hours total
- Medication Management: as prescribed
We monitor your response with the PHQ-9 depression inventory and clinical interview, and adjust the plan if we are not seeing the response we expect.
What outcomes to expect
For Accelerated TMS (SWIFT protocol):
- 87.8% response rate (50% or greater reduction in PHQ-9)
- 78% remission rate (PHQ-9 below 5)
- Source: Published SWIFT trial data. Hanlon et al., Brain Stimulation, 2026
For Spravato in TRD, the pivotal Janssen trials (Janssen TRANSFORM-2 and SUSTAIN-1 trials) demonstrated statistically significant improvement over oral antidepressant plus placebo at four weeks, with durability of response at twelve months.
Individual results vary. Depression severity, number of prior failed treatments, concurrent medical conditions, and treatment adherence all affect outcomes. Dr. Roth will discuss realistic expectations based on your specific history during your evaluation.
6 days
Patients complete acute SWIFT™ Accelerated TMS in 6 Days *
* Source: Landmark Data Validate BrainsWay’s SWIFT™ Deep TMS, Beginning a New Era in Depression Treatment
~88%
Patients experience significant improvement from depression *
78%
What does treatment cost?
With insurance: We are in-network with Aetna, Anthem, Cigna, Humana, Medicare, TRICARE, and UnitedHealthcare. Most patients pay only their standard specialist copay or coinsurance per session.
Self-pay: Accelerated TMS (SWIFT) is $7,500 all-inclusive — evaluation, every session, follow-ups, and 6-month touch-ups. Third-party financing is available.
Our Patient Care team verifies your specific benefits before any treatment begins.
Frequently asked questions
Q. How do I know if I'm treatment-resistant?
A. TRD is typically diagnosed when a patient has tried at least two different antidepressants at adequate dose and duration (usually 4-6 weeks each) without achieving full remission. A clinical evaluation at Bluegrass AMH can confirm whether TRD is the right diagnosis.
Q. Is TMS or Spravato better for TRD?
A. Both are FDA-approved for TRD and both work. Deep TMS has no sedation, no systemic side effects, and no driving restrictions, but requires 20-minute daily visits over 12 weeks (or 6 days for Accelerated). Spravato works faster for many patients but requires a 2-hour supervised recovery after each session and you cannot drive the day of treatment. Dr. Roth or Nurse Woods will review the trade-offs based on your situation.
Q. How long before I will feel better?
A. Accelerated TMS patients often notice changes during or shortly after the 6-day treatment week. Standard Deep TMS patients typically see initial response at week 3-4. Spravato patients may see rapid-acting effects within 24 to 72 hours of the first dose. Individual response varies.
Q. Will insurance cover my treatment at Bluegrass Advanced Mental Health?
A. Most major commercial insurance plans cover Deep TMS and Spravato for TRD when medical criteria are met. We are in-network with Aetna, Anthem, Cigna, Humana, Medicare, TRICARE, and UnitedHealthcare. Our Patient Care team verifies your specific benefits before you commit. Call (502) 856-7378 for a free insurance verification.
Q. How do I get started?
A. A free 5-minute screening call with our Patient Care team at (502) 856-7378 or through our online new patient application. The in-person evaluation typically happens within one week of the screening call.
Ready to talk?
A 5-minute screening call with our patient care team tells you if TMS or Spravato may be a fit, verifies your insurance coverage, and can schedule your first appointment. Call 502-856-7378.
