In this post, you’ll learn about extreme treatments for treatment resistant depression, anxiety, or PTSD.
When you’ve tried two or three or six treatments for your depression, anxiety, or PTSD and nothing helps, you might feel even more hopeless, like a fulfilling life is not possible for you. But I have good news for you.
There are literally 500–five hundred treatments for depression. We’re talking treatments for severe forms of depression, anxiety, and PTSD. And most of them are surprisingly effective.
So let’s explore 9 interventions that science has shown to improve treatment resistant mental health conditions–and at the end I’ll share what hasn’t been proven to work. Some of these might be considered last-ditch efforts to treat treatment-resistant mental health conditions, but if you’ve been there, you know how desperate you feel and why it might be worth talking with your psychiatrist about these.
Exploring 500 Treatment Options for Depression
I think people think I’m exaggerating when I say there are 500 treatment options for depression, but I’m serious. [In fact, I built this flow chart to show you how I would move through options with a client. We’ll use Treatment Resistant Depression as an example.
Oh yeah, and let’s just remember, we don’t know what causes depression. It is a real disorder, but it’s defined by a cluster of symptoms. You need to have 5 of these 9 symptoms for at least 2 weeks, and then you “have it”. But when the symptoms go away – we don’t even have a word for that “not depression”, but for the sake of this video, we’ll say remission. What I’m trying to say is, don’t just assume depression or anxiety is permanent when we don’t even know what causes it. We probably need to explore a bunch of options to give our brain and body the best chance at healing.
Okay, we are going to get down here, with the more extreme treatment options, but first let’s start at the top with the more typical conditions.
Check for medical conditions. You should go to your doctor and get basic lab work done, many of these like low-thyroid, anemia, diabetes, and other vitamin or hormone deficiencies are easy to test for and either rule-out or treat. My dad used to experience pretty bad depression, but when he got treated for low thyroid, he saw massive improvements. In addition to the common diseases that can contribute to depression, there are other disorders that are much more rare. For example, a woman in Australia got depression out of the blue, no life changes, no trauma, she went from being fine to being suicidal. Doctors tried all of the standard treatments to no avail. Eventually they found that she had a parasitic worm in her brain, and when they removed it, things got better.
Treat Substance abuse. Alcohol is a depressant.
Standard Treatments
Therapy, Medication, lifestyle changes, different types of therapy (narrative, trauma, somatic, etc in addition to CBT), different types/doses of medication, environmental changes (leave your abusive husband, get a different job, etc).
Do you need to learn more adaptive techniques for solving problems (ie how to budget, how to get training for a better job) or improve relationships? I have dozens of videos to help you grow your mental health skills. If you have a sense for a skill you are lacking, check out my playlists or courses to get started.
Now we’re going to jump into extreme treatment options…
OK, when none of this is working, or if your case is really severe-
Get a second opinion to check for correct diagnosis (is it actually Bipolar, dysthymia, or a personality disorder that requires different treatment) Is it grief, trauma, or executive dysfunction (ADHD)? Is it PTSD, or Autism? Is it burnout? Each of these disorders has a ton of different treatment options that open up when you get the right diagnosis. I once got an email from a woman whose daughter had been treated for social anxiety for years, but from the email I could tell that she most likely actually had OCD. Later, when she got admitted to the hospital, it was confirmed that OCD was a more accurate diagnosis. This led to much better treatment outcomes.
There’s also the option to engage in an Intensive Outpatient Program, or a hospitalization. IOP’s usually have a lot of therapy and support. A hospitalization usually focuses on keeping you alive, getting an accurate diagnosis, and medication management.
OK! Now we’re onto some of these great treatment options when nothing else is working!! These are medical treatments that therapists like me don’t provide, you would work with your psychiatrist or medical care team to do them. I’m just going to tell you about them so you can be informed when you talk with your doctor.
1. Electroconvulsive Therapy (ECT)
ECT involves a series of brief electrical pulses delivered to the brain while you’re under general anesthesia. These pulses trigger a controlled seizure, which is thought to reset the brain’s neural activity. A typical course includes 6–12 sessions, spaced over a few weeks. Modern ECT techniques are highly refined, using lower electrical currents to minimize side effects.
Research shows that ECT can be highly effective for severe depression. 70–90% of patients experience significant relief within weeks, and 50% experience remission, though maintenance treatments or other therapies are often needed to prevent relapse.
This is a pretty extreme treatment that can be life saving for severe depression, but it can have side effects including temporary memory loss, confusion, and stigma associated with the treatment. It is more likely to be covered by insurance than other treatments, but you’ll need someone to take you to the appointment and stay with you while you recover.
2. Transcranial Magnetic Stimulation (TMS)
During TMS, doctors place a magnetic coil near the scalp to deliver magnetic pulses to specific brain areas involved in mood regulation. The treatment is done while awake and typically lasts 20–40 minutes per session, five days a week, for about 4–6 weeks. (That’s a lot of treatments!)
Studies suggest that TMS can be effective for treatment-resistant depression, with up to 50% of patients showing improvement and about a third achieving remission. It’s less invasive than ECT and doesn’t require anesthesia, and it generally has a lot less side effects. Usually just a scalp tingle or maybe headaches.
But, it’s less effective for severe or psychotic depression compared to ECT. The need for frequent sessions can also be inconvenient for some patients. And it may be less likely to be covered by insurance.
3. Ketamine
Ketamine is a drug that has been used as an anesthetic for decades, but it’s emerged as a fast-acting treatment for depression, particularly treatment-resistant depression and suicidal ideation. It’s also being explored for anxiety, PTSD, and chronic pain. It’s believed that the drug works by altering glutamate signaling in the brain, which can rapidly improve mood.
What the Treatment Is Like:
Ketamine is administered either via intravenous infusion (IV) in medical settings or as a nasal spray (esketamine). A single session lasts about 40 minutes to an hour, and most patients receive a series of treatments over a few weeks.
Research shows ketamine can reduce depressive symptoms within hours, making it a potential lifesaver for those in crisis. Around 50–70% of patients respond positively, though the effects may last for only a few months and require maintenance treatments.
The cons include feeling dissociated or trippy during treatment, and the potential for dependency. We still don’t have enough data to know the long-term safety and effectiveness. Also, esketamine is used on-label and is FDA approved, but the more effective IV therapy is being used off-label, so your insurance may not cover it.
With ECT, TMS, and Ketamine these treatments seem to be resetting the brain, they help erase old, rigid neural pathways, kinda like shaking an etch-a-sketch. They may help improve neuroplasticity- the ability the brain has to make new pathways and learn new skills. But, like an etch-a-sketch, you still need to do the work of drawing the new, healthy pathways. That’s why these treatments are much more effective when paired with therapy.
4. Vagus Nerve Stimulation
VNS involves stimulating the vagus nerve, which plays a crucial role in regulating mood and emotional responses. This can be done invasively, through a surgically implanted device, or non-invasively, using external stimulation methods. This device sends electrical signals to the vagus nerve, which helps regulate brain activity. VNS has been explored for treatment-resistant depression, anxiety disorders, and PTSD.
Around 37–67% of patients see improvement over time, though results can take months to years.
While it’s generally safe, potential side effects include voice changes and throat discomfort. VNS is usually considered when other treatments haven’t worked. It is FDA approved for the treatment of Epilepsy and Treatment Resistant Depression.
5. Psilocybin
Psilocybin, the active ingredient in “magic mushrooms,” is being studied as a treatment for depression, anxiety (particularly in terminal illness), PTSD, and substance use disorders.
So you take the drug under medical supervision in a controlled setting, often with guided support from a mental health provider to help process the experience. The psychedelic effects last 4–6 hours, and patients often report profound emotional or spiritual insights.
Emerging research shows psilocybin can produce significant and lasting reductions in symptoms of depression and anxiety after just one or two sessions. It appears to help “reorganize” brain networks and promote emotional flexibility, with effects lasting weeks to months. Perhaps best done in conjunction with therapy to help maintain effects.
The profound, often life-changing insights are a major pro, but psilocybin isn’t for everyone. Side effects can include intense emotional experiences or anxiety during the trip. Research also shows that high or repeated doses can lead to psychosis. It’s really important to have proper screening and support during treatment to reduce risks. Not FDA approved but it has been given the “Breakthrough Therapy” designation to allow for more research. It’s also not widely available yet and it’s illegal in many places but there are a few states allowing this treatment legally as part of the research process.
So you can see we’re moving from FDA-approved treatments toward experimental treatments…Let’s talk about the
Lobotomy haha just kidding, they don’t do that anymore. Thank goodness.
OK, let’s talk about some more fringe treatments- they show some interesting anecdotal results, but I don’t think there’s enough evidence to understand who they work for and why.
6. Stellate Ganglion Block (SGB):
SGB involves injecting a local anesthetic near the stellate ganglion—a collection of nerves in the neck—to modulate the sympathetic nervous system. This procedure has been explored as a treatment for conditions like post-traumatic stress disorder (PTSD) and anxiety disorders.
Studies have shown promising results. A 2023 study involving 285 patients reported significant reductions in anxiety symptoms following SGB treatments.
SGB is generally considered safe, with minimal side effects. However, as with any medical procedure, there are risks, including potential complications from the injection. It’s also worth noting that while many patients experience relief, the duration of symptom improvement can vary, and some may require repeat treatments.
Alternative treatments
By the way… Exercise, Nutrition, Sleep, and Social connection have the best evidence behind them. So instead of doing that, let’s insert poop into our guts!
7. Fecal transplants
Fecal Microbiota Transplantation (FMT) involves transferring stool from a healthy donor into a recipient’s gastrointestinal tract to restore a balanced gut microbiome.
The gut-brain axis—the communication network between the gastrointestinal tract and the brain—plays a crucial role in mental health. FMT may influence this axis by altering gut microbiota composition, potentially affecting neurotransmitter production, immune function, and inflammation, all of which are implicated in mental health disorders.
Emerging research suggests that FMT may have potential benefits for certain mental health conditions, particularly major depressive disorder (MDD) and anxiety disorders.
As always, more research is needed, but a case report documented significant symptom reduction in a patient with MDD following FMT, with effects lasting at least four weeks post-treatment. You probably shouldn’t do this on your own. (But one lady did make a smoothie with her partner’s poop, and reported some pretty good results)! Maybe she was inspired by Miss Hilly.
8. Metabolic treatments:
Speaking of eating things to relieve depression…I made a video on this, but long story short- treatments like intermittent fasting, and a keto diet, and possibly even weight loss medications like Ozempic have shown some super promising early results for treating severe mental illness including bipolar disorder, schizophrenia, and major depressive disorder.
A medical keto diet is 80-90% fats, with very few carbs, and you should do it with a metabolically informed doctor. It can help stabilize metabolism, which seems to really support brain health. Research is just beginning for this emerging treatment, but it’s certainly worth exploring.
9. Cold Water immersion
Cold water immersion (CWI), which includes practices like ice baths, cold showers, and open-water swimming.
Studies indicate that CWI can elevate mood and alleviate depressive symptoms. One case study reported that a woman with major depressive disorder experienced significant improvement after regular cold-water swimming sessions, eventually discontinuing her medication and remaining symptom-free a year later.
Research suggests that cold exposure increases levels of neurotransmitters like norepinephrine and dopamine, which are associated with improved mood and reduced anxiety.
Regular exposure to cold water might enhance the body’s resilience to stress by decreasing cortisol levels, the hormone responsible for stress responses. It also might also stimulate the parasympathetic nervous system, promoting relaxation and reducing stress. And it might help reduce inflammation.
So, cold water immersion is promising, it’s probably not safe for everyone. It can put stress on the heart, and you shouldn’t do it alone.
Alternative Treatments-
OK, I had heard about red-light therapy and thought it was worth adding to this list, but when I looked at the research, there’s basically no evidence that it’s helpful for depression. And there’s a long list of treatments that fit in the category of little-to no high-quality evidence that they are effective treatments for Treatment-Resistant Depression. And that’s because either there aren’t Randomized Controlled Trials, or the trials showed no effect. Here’s the list:
Other Alternative Treatments with Limited Evidence
Crystals and Gemstones.
Homeopathic medicine: Uses highly diluted substances to “treat” conditions
Energy Healing (e.g., Reiki):
Essential Oils (Aromatherapy):
Magnet Therapy (Static Magnets):
Herbal Supplements Without Evidence: Examples include St. John’s Wort (for severe depression), kava, or ginkgo biloba, which lack consistent research or are known to interact with medications.
Psychic Healing/Mediums:
Color Therapy
Negative Ion Therapy
Earthing or Grounding
Now I’m not saying that these don’t work, I’m saying “There’s no evidence that these work”, so I would not recommend that you spend a lot of money on these treatments.
OK, so if you have Treatment Resistant Depression, there’s still a ton of options for you to try. So don’t give up if you haven’t yet found what works for you. A beautiful life where you feel all the emotions and where you feel empowered to pursue your goals and dreams is possible. Keep exploring the treatments for improving your mental health.
Thanks for reading, keep your head up, and take care.
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