What does “treatment-resistant depression” (TRD) mean?

Depression is described as treatment-resistant when a patient has already received several different treatments without the desired improvement, and symptoms continue despite therapy. In clinical practice, a diagnosis of TRD may be considered after two different antidepressants, given at an adequate dose and for a sufficient duration, have proved ineffective.

How do I know if I may be affected?

If you have taken at least two antidepressants at the right dose and for the right length of time, and your condition has not improved significantly, you may also be living with TRD. It is more common among people with long-standing depression, those who experience recurrent episodes, and those whose depression is accompanied by other psychiatric or physical health problems.

Why should I turn to Panoráma?

For those who

• have struggled with depression for a long time without lasting relief,
• have not responded to standard medication,
• and are open to new approaches,

Panoráma offers

• thorough assessment,
• review and fine-tuning of previous treatments,
• a new, personalised treatment plan, and
• where clinically indicated, an innovative esketamine programme with Spravato®, available only to a limited extent in private healthcare in Hungary but supported by state reimbursement – always under professional supervision and in a safe outpatient setting.

What happens if I come to Panoráma’s TRD Clinic for an assessment?

The assessment typically includes the following steps:

1. Questionnaires

You complete these at home, so at your first appointment we already have key information to work with.

2. Psychiatric assessment

You meet with a consultant psychiatrist, who will discuss your symptoms, previous diagnoses and treatments in detail—providing a second opinion where relevant.

3. Additional tests

Blood tests and an ECG are usually required. If needed, psychological tests may also be recommended.

4. Medication level monitoring

A blood test helps us check whether your prescribed medication is present in the right concentration in your body. This clarifies whether your treatment is truly ineffective, or whether your body processes the medication differently.

On the basis of these results, we prepare a personalised treatment plan for you.

How much does the assessment cost?

The cost is made up of the psychiatric consultations (initial assessment, follow-up appointments), any psychological sessions, and the additional tests performed—usually blood tests and ECG.

What will the treatment plan include?

The plan is tailored to your individual needs and may recommend one or more of the following:

• medication, or adjustment of existing treatment with more precise dosage,
• psychotherapy, individually and/or in a group setting,
• body-focused therapies such as manual therapy, which can have both physical and psychological benefits,
• innovative esketamine therapy (Spravato® nasal spray), always under medical supervision.

Nothing has helped me so far. Can I just start with the nasal spray?

It is important to stress that Spravato® treatment (esketamine therapy) can only be recommended where clinically justified, and only alongside an established antidepressant treatment plan—and always following a thorough assessment.

One aim of the assessment is to confirm the diagnosis. While “failure of two antidepressants” may sound straightforward, the exact definition of an adequate dose needs careful review, including blood tests to measure drug levels. Co-existing medical or psychiatric conditions may also require previous treatments to be re-evaluated. The purpose of the assessment is to recommend the treatment most likely to be effective for you.

For this reason, we must follow the clinical protocol in your best interest; it would be unethical to deviate from it simply on request.

Esketamine therapy is costly. Can I be sure it will work?

In short: there can be no absolute guarantee. Depression, including TRD, is highly individual, meaning that different people may respond to different treatments or treatment combinations. That is why we invest great care in ensuring the assessment leads to the therapy with the best chance of success in your case.

That said, esketamine therapy has been shown to be effective in many patients who did not respond adequately to other treatments. Where clinically indicated, it may be recommended by your doctor as a safe and evidence-based option, with the potential to bring meaningful and lasting improvement to your quality of life.