Treatment-Resistant Depression Care
Specialized medical evaluation and evidence-based advanced therapies
Treatment-resistant depression is a clinical condition characterized by an inadequate response after the use of at least two different antidepressants, taken at the correct dose and duration. In these cases, persistent symptoms can deeply affect function, quality of life, and clinical risk.
Managing treatment-resistant depression requires specialized medical care, diagnostic reassessment, investigation of associated factors, and careful consideration of advanced therapeutic strategies, always on an individualized basis.
Intrador provides medical evaluation for patients with treatment-resistant depression, integrating expertise in neuromodulation, pain management, pharmacology, and clinical safety, in coordination with psychiatric follow-up.
What defines treatment-resistant depression?
Treatment-resistant depression is considered when:
- there is no satisfactory clinical response after two different antidepressants;
- treatments were conducted appropriately;
- symptoms persist in a significant way.
This does not mean a lack of alternatives, but the need for a more in-depth evaluation.
Advanced treatment strategies
For selected patients, strategies may include:
- pharmacologic optimization;
- neuromodulation;
- use of esketamine through different routes of administration, according to medical criteria.
Esketamine in treatment-resistant depression
Esketamine has a mechanism of action distinct from traditional antidepressants, acting on NMDA receptors and neuroplasticity processes. Its use may be considered in specific cases of treatment-resistant depression, always after careful medical evaluation.
Intrador primarily uses parenteral esketamine in an off-label context, supported by scientific evidence and CFM Opinion No. 20/2024, and in selected cases also uses the intranasal route (Spravato®).
Specialized medical evaluation
The indication of any advanced therapy requires:
- detailed clinical evaluation;
- review of previous treatments;
- risk–benefit analysis;
- free and informed consent.
Legal notice
The use of esketamine may involve off-label use. According to CFM Opinion No. 20/2024, this practice is ethically permitted when conventional treatments have failed, there is scientific rationale, proper medical record documentation, and a free and informed consent form.
This content is informational and does not replace an in-person medical consultation.
Clinically Reviewed by:
Dr. Helio Widson Alves Pinheiro
Pain Medicine | Acupuncture
CRM/PE 21167 | RQE 2217, 2808
This content is informative and does not replace individual medical evaluation.
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Fundador da Clínica Intrador, médico especialista em Medicina da Dor e Acupuntura, com atuação em tratamentos intervencionistas e neuromodulação.
Note: This content is for educational and informational purposes only. The information is based on scientific evidence and the clinical practice of the Intrador team, but it does not replace individualized medical evaluation. Conduct, indications, and treatments must be defined after medical consultation.
Clinical reviewer: Dr. Helio Widson Alves Pinheiro · Pain Medicine | Acupuncture · CRM/PE 21167 | RQE 2217, 2808
Published on: January 17, 2026
Reviewed on: January 29, 2026
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