Treatment-Resistant Depression Care in Littleton, Colorado
If two or more antidepressants haven’t brought enough relief, a fresh evaluation can clarify why and identify treatments that work through different mechanisms. This is a central focus of care at Fortifying Wellness.
Your Options at a Glance
Littleton, CO 80128 · Telehealth across ColoradoYou’re Not Imagining It
When you’ve done everything right and still feel stuck
Many of the people we work with arrive exhausted, as much by the process of treating depression as by the depression itself. Years of trying medications, waiting six weeks, adjusting doses, switching, augmenting. Therapy that helps a little, then plateaus. The quiet fear that maybe this is just how life is going to feel.
In STAR*D, a large real-world study of antidepressant treatment, the likelihood of remission generally declined across successive treatment steps. That does not mean further treatment is futile. It means the next decision should follow a careful review of diagnosis, prior dose and duration, side effects, co-occurring conditions, and options that work through different mechanisms.
It might be time for advanced treatment if…
- You’ve tried two or more antidepressants without lasting relief
- Side effects keep forcing you to stop medications that partially help
- Depression keeps returning despite staying on your regimen
- Low mood, flatness, or hopelessness is costing you work, relationships, or joy
A note from Dr. Wagner
“Treatment resistance is a description of what’s been tried — never a verdict on you. Some of the most dramatic recoveries I’ve witnessed have been in people who walked in believing nothing would ever work.”
Your Options
Three evidence-based paths beyond antidepressants
Each works through a different mechanism than oral medication, and each is delivered in our Littleton clinic under medical supervision.
TMS Therapy
Non-invasive magnetic stimulation delivered without anesthesia or sedation. Most people resume routine activities afterward; coverage depends on the device, protocol, diagnosis, and plan criteria.
How TMS worksSpravato® (Esketamine)
FDA-approved nasal spray for adult treatment-resistant depression, administered in our monitored office. Coverage and prior-authorization criteria vary by plan.
How Spravato worksIV Ketamine Therapy
Physician-directed ketamine infusions administered and monitored by our medical team. Psychiatric use is off-label; some patients experience earlier improvement, but response and duration vary.
How IV ketamine worksNot sure which is right for you?
That’s exactly what the comprehensive evaluation is for. Dr. Wagner reviews your treatment history, health, and insurance coverage, then walks through the trade-offs with you, including whether a smarter medication strategy or a psychotherapy referral should come first.
What to Expect
From first call to feeling like yourself
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1
Free consultation
A low-pressure conversation about what you’ve tried and what options make sense. We check your insurance benefits before you commit to anything.
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2
Comprehensive evaluation
A 90-minute appointment with Dr. Wagner covering your full history, medications, and goals, ending in a clear diagnosis and a personalized plan.
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Treatment, measured honestly
Whichever path you choose, we track your symptoms with validated scales so progress is visible, and the plan adapts if it isn’t.
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4
Staying well
Relapse prevention matters as much as relief. We build a maintenance plan and coordinate with your therapist or primary care team for the long run.
Common Questions
Treatment-resistant depression FAQs
What counts as “treatment-resistant” depression?
Clinically, depression is generally considered treatment-resistant after two or more adequate antidepressant trials haven’t brought sufficient relief. That treatment history can be a reason to reassess the diagnosis, prior trials, and options that work through different mechanisms.
Which should I try first: TMS, Spravato®, or ketamine?
The truth is, it depends on your specific situation. To determine what makes the most sense and what may provide the most clinical benefit for your care, Dr. Wagner reviews both your medical and psychiatric history. Some treatments are eligible for insurance coverage with appropriate prior authorization; others are not. Don’t stress: we verify your benefits and make things clear before you decide.
Do I have to stop my current antidepressant?
Usually not. TMS, Spravato®, and ketamine are typically added alongside your existing medication, and we coordinate with your current prescriber or therapist whenever that helps your care.
Is any of this covered by insurance?
Coverage for TMS and Spravato® depends on the specific plan, diagnosis, treatment history, device or protocol, and prior-authorization criteria. IV ketamine for depression is off-label and is typically self-pay. We verify benefits, handle prior authorization, and provide a written estimate before treatment begins. Insurance details →
Related reading
There Are Still Options
Let’s find an approach that fits your needs
A free consultation with our Littleton team: your history heard, your questions answered, your benefits verified.
7345 S. Pierce St, Suite 205, Littleton, CO 80128 · Serving Littleton, Ken Caryl, Columbine, Highlands Ranch, Centennial, Lone Tree, Englewood, Lakewood & the south Denver metro