Last updated: October 2026. Reviewed by Dr. Steven Radowitz.
Every October, the posts come back: reach out, talk to someone, get help. If you’ve already done that, maybe more than once, those messages can land strangely. You saw a doctor, tried one medicine, then another, and still feel stuck. Depression Awareness Month, part of the Mental Health America 2026 awareness calendar, is for you too.
A 2021 national analysis estimated that about 2.76 million US adults live with depression that hasn’t lifted after at least two antidepressants, often called treatment-resistant depression. Nushama’s Manhattan center offers three treatments for it, Spravato, IV ketamine and TMS, under one roof, and the same clinical team can stay with you if you move from one to another. We’ll walk through each one below.
What does it mean if your depression treatment “hasn’t worked”?
It means your depression hasn’t improved enough after at least two antidepressants, each taken at the right dose and for long enough to have a fair chance. The word “resistant” describes how the depression has responded to medicine so far. It says nothing about your effort or character.
About 19.7 million US adults had a major depressive episode in 2025, according to a national survey by the Substance Abuse and Mental Health Services Administration. That’s about 7 in every 100 adults in a single year. A major depressive episode means at least two weeks of low mood or lost interest in daily life, along with other symptoms such as problems with sleep, eating, energy or concentration. Among adults treated with medicine for depression, about 3 in 10 meet the definition of treatment-resistant depression. So if you need more than the first options, you’re in good company.
What makes Nushama different?
Nushama describes its purpose as humanizing medicine, and its name comes from the Hebrew word for soul, breath or life force. Here’s what that looks like in practice:
- The whole person, not just a diagnosis. Psychiatry, newer treatments that support neuroplasticity (the brain’s ability to form new connections), psychotherapy and supportive care are brought together. Psychotherapy is another name for talk therapy.
- Safe, supported and seen. Nushama believes people heal best when they feel all three. Its spaces are designed to feel calm, beautiful and human, bringing hospitality into medicine.
- Medically led. Careful screening, thoughtful preparation and medical monitoring come first, with physicians, nurse practitioners and registered nurses on the team.
- Science and tradition together. Nushama says it is guided by ancient traditions and pioneering science.
Your first consultation starts with your history and goals, and the team recommends a treatment only when it’s the right fit for you.
What can Nushama offer when antidepressants haven’t been enough?
Nushama offers three treatments that work differently from a daily antidepressant, plus integration support to help you make the most of them.
Spravato (esketamine nasal spray)
Spravato is a nasal spray made from esketamine, a close relative of ketamine. It’s FDA-approved for treatment-resistant depression, and since January 2025 it can be used on its own, without a daily antidepressant.
How Nushama keeps you safe: The FDA label calls for at least two hours of observation after each dose, so you’ll rest in the clinic while staff check on you. Feeling detached or dreamy, which clinicians call dissociation, along with dizziness and nausea, are common side effects. Blood pressure can rise after a dose, so it’s checked before your dose and watched afterward. You’ll need a ride home, since you can’t drive until the next day after a restful sleep. Nushama offers Spravato in Manhattan, Rockland and Aventura, and in Manhattan a Columbia School of Social Work intern will be able to offer you two complimentary extended integration sessions during your protocol.
IV ketamine
IV stands for intravenous: the medicine is given as a slow drip into a vein, called an infusion. Ketamine is FDA-approved as an anesthetic, the kind used to put people to sleep for surgery, but not for depression. When doctors use it for depression, that’s called off-label, which simply means prescribing an approved medicine for a different use. In a large 2023 study of about 400 people with treatment-resistant depression, 55% had their symptoms cut at least in half with ketamine. That’s a little over half.
How Nushama keeps you safe: At Nushama, every infusion is given under medical monitoring, because ketamine can raise blood pressure and cause dissociation. Screening comes first, since it may not suit people with uncontrolled high blood pressure, serious heart disease or a history of psychosis. Psychosis means losing some contact with reality. Before your first infusion, the team checks things like your blood pressure and runs an EKG (a quick heart rhythm test), and each infusion comes with preparation and integration support.
TMS (transcranial magnetic stimulation)
TMS uses magnetic fields from a coil placed against your scalp to stimulate nerve cells in a part of the brain involved in mood. You stay awake, with no altered state, and can usually get on with your day afterward. Nushama offers TMS at its Manhattan center, and the care team can help you find a schedule that suits you.
What to know about safety: Side effects can include scalp discomfort and mild headaches. Seizures are very rare, about 3 in every 100,000 sessions in a 2021 study.
Integration: making sense of the change
Integration is time after a session, with a therapist or coach, to make sense of what you felt. Treatments like these may leave the brain more open to new patterns for a while. At Nushama, therapists and integration coaches help members make sense of each experience and carry it into daily life.
Are there other options worth discussing?
Yes. Before or alongside Nushama’s treatments, your care team may look at:
- Whether the basics got a fair chance: the dose, how long each medicine was taken, side effects, sleep, alcohol, thyroid and other health conditions.
- Switching or adding a medicine: another antidepressant, or an add-on such as lithium, thyroid hormone or certain antipsychotic medicines, taken alongside your antidepressant to boost its effect. These usually take 4 to 8 weeks to judge, and it’s important not to stop a medicine without your provider’s help.
What should you ask your doctor this Depression Awareness Month?
Bring these five questions to your next appointment, whether that’s at Nushama or with your own doctor:
- Do I meet the definition of treatment-resistant depression?
- What haven’t we tried yet?
- What are the safety trade-offs of each option, given my health history?
- How will we know whether this is helping?
- What’s the plan if this doesn’t help?
FAQ
Does treatment-resistant depression mean my depression can’t be treated? No. It means the first medicines didn’t help enough, and there are other options to try. Your care team can help you find the one that fits.
Do I have to stop my antidepressant to start at Nushama? Not necessarily. Spravato can now be used with or without one. Please don’t stop anything on your own; the team will plan any changes with you and your prescriber.
Can I try more than one treatment? Yes. At Nushama, the same team can stay with you if you move from one treatment to another.
How do you get started at Nushama?
You start with a consultation, where the team gets to know your history and what you’ve tried, and helps you choose what comes next. Nushama has centers in Manhattan at 515 Madison Avenue, 21st floor, and in Rockland County, plus a location in Florida. When you’re ready, book a consultation with Nushama’s care team.
If you’re having thoughts of suicide or don’t feel safe right now, please reach out today rather than waiting for an appointment. Call or text 988, or in New York City use NYC 988, which offers call, text and chat support in more than 200 languages. You can also go to the nearest emergency room.