Treatment-Resistant Depression
When depression persists despite trying multiple antidepressants and therapy, it is considered treatment-resistant—affecting about 15-30% of patients. Symptoms include ongoing sadness, low energy, concentration issues, sleep/appetite changes, and feelings of hopelessness. Dr. Levinson specializes in advanced interventional options like TMS, Spravato® (esketamine), ECT, medication optimization via Genesight® testing, and coordinated care to restore hope and function when standard approaches fall short. A thorough 90-minute initial evaluation helps create a personalized plan.
What is Treatment-Resistant Depression?
- Depression that doesn't improve after trying 2+ antidepressants
- Medications provide little to no symptom relief
- Side effects outweigh benefits of treatment
- Symptoms return quickly when medication is stopped
- Therapy alone isn't providing sufficient improvement
Common Symptoms
- Persistent sadness or empty feelings
- Loss of interest in activities once enjoyed
- Fatigue and decreased energy
- Difficulty concentrating or making decisions
- Sleep disturbances (too much or too little)
- Appetite changes and weight fluctuations
- Feelings of worthlessness or excessive guilt
- Physical symptoms without clear medical cause
Our Specialized Approach
- Comprehensive evaluation of treatment history
- Genetic testing to optimize medication selection
- Advanced brain stimulation treatments (TMS, ECT)
- Rapid-acting treatments (ketamine therapy)
- Combination therapy approaches
- Regular monitoring and adjustment
- Coordination with other healthcare providers
What to Expect
- Initial 90-minute comprehensive evaluation
- Review of all previous treatments and responses
- Discussion of advanced treatment options
- Personalized treatment plan development
- Insurance verification and prior authorization
- Regular follow-up and progress monitoring
- Adjustment of treatments based on response
⚠️ When to Seek Immediate Help
If you're experiencing thoughts of suicide, self-harm, or feel like you're in crisis, please seek immediate help.
Call 988 (Suicide Prevention Lifeline)Bipolar Disorder
Bipolar disorder features intense mood swings, from manic or hypomanic highs (elevated energy, reduced sleep need, risky behavior) to deep depressive lows. Accurate diagnosis often takes years, but 80% of patients can achieve stability with proper treatment. Dr. Levinson offers comprehensive care including mood stabilizers, antipsychotics, long-acting injectable medications (for better adherence and fewer relapses), TMS for bipolar depression phases, and integrated psychotherapy support to promote long-term balance and quality of life.
Types of Bipolar Disorder
- Bipolar I: At least one manic episode lasting 7+ days
- Bipolar II: Hypomanic and depressive episodes
- Cyclothymic Disorder: Chronic mood instability
- Mixed Episodes: Simultaneous manic and depressive symptoms
- Rapid Cycling: 4+ episodes per year
Manic Episode Signs
- Elevated, expansive, or irritable mood
- Decreased need for sleep (feeling rested after 3 hours)
- Grandiosity or inflated self-esteem
- Racing thoughts or flight of ideas
- Increased goal-directed activity
- Excessive involvement in risky activities
- Distractibility and poor judgment
Depressive Episode Signs
- Persistent sadness or hopelessness
- Loss of interest in activities
- Significant weight loss or gain
- Sleep disturbances
- Fatigue or loss of energy
- Difficulty concentrating
- Feelings of worthlessness or guilt
- Suicidal thoughts or behaviors
Long-Acting Injectable Benefits
- Improved medication adherence
- Steady medication levels in bloodstream
- Reduced risk of relapse
- Monthly or quarterly dosing schedules
- Decreased daily pill burden
- Better long-term stability
- Simplified medication management
Schizophrenia & Psychotic Disorders
Schizophrenia and related psychotic disorders involve symptoms like hallucinations, delusions, disorganized thinking, and challenges with motivation or social functioning—affecting about 1.1% of adults. With evidence-based treatment, up to 70% see meaningful improvement. Dr. Levinson provides expert medication management (including long-acting injectables for steady symptom control and reduced hospitalization risk), coordinated multidisciplinary care, and ongoing monitoring to support recovery, independence, and stability.
When Specialized Care Is Needed
- Ongoing hallucinations or delusions despite treatment
- Frequent hospitalizations or emergency visits
- Difficulty tolerating or adhering to medications
- Co-occurring mood, anxiety, or substance use disorders
- Cognitive or functional decline affecting daily life
- Need for coordinated care across providers and settings
Common Symptoms
- Hallucinations (hearing or seeing things others do not)
- Delusional beliefs
- Disorganized speech or behavior
- Reduced emotional expression or motivation
- Cognitive difficulties (attention, memory, executive function)
- Social withdrawal
- Sleep and appetite disruption
- Anxiety, depression, or agitation
Our Specialized Approach
- Comprehensive psychiatric evaluation and longitudinal care planning
- Careful medication selection and side-effect management
- Long-acting injectable medication evaluation when appropriate
- Monitoring for metabolic and neurological side effects
- Coordination with therapists, primary care, and case managers
- Support for adherence and relapse prevention
- Family education and involvement (with consent)
- Crisis planning and safety coordination
What to Expect
- Extended initial psychiatric evaluation
- Review of prior hospitalizations and medication trials
- Discussion of goals focused on stability and functioning
- Development of a personalized, stepwise treatment plan
- Insurance coordination for higher-complexity care
- Regular follow-up with ongoing adjustments
- Emphasis on continuity rather than quick fixes