CONTENT NOTE
This episode discusses depression, suicidal thoughts, and suicide prevention.
In the U.S., call or text 988 or visit https://988lifeline.org for free, confidential crisis support.
If there is immediate life-threatening danger, call 911 or go to the nearest emergency department.
Outside the U.S., find local support at https://findahelpline.com.
What happens when medication and therapy have not brought enough relief?
Board-certified psychiatrist Dr. Mark Blair joins Greg, Rich, Liam, and Sarah to explain treatment-resistant depression and why âtreatment-resistantâ does not mean âuntreatable.â
They discuss the importance of reviewing the full diagnosis and treatment history before deciding what comes next.
Dr. Blair explains Deep TMS with the BrainsWay H-coil, Spravato (esketamine nasal spray), IV ketamine used off-label for depression, and when ECT may be considered.
He also discusses treatment access, monitoring, realistic expectations, choosing a responsible provider, crisis warning signs, asking directly about suicide, and creating a written safety plan before a crisis.
Episode 52 also marks one year of The Support & Kindness Podcast.
CHAPTERS
00:00 Welcome, content note, and 988
01:04 When depression treatment has not helped enough
02:06 Meet Dr. Mark Blair
03:08 Hospital crisis care and founding Optimum
05:08 Clinical depression, sadness, grief, and stress
06:42 What treatment-resistant depression means
08:32 Rechecking the diagnosis and treatment history
10:30 Deciding what treatment may come next
12:42 TMS, Deep TMS, and the BrainsWay H-coil
16:12 Spravato and IV ketamine
21:02 Choosing a provider, access, cost, and safety
23:10 Crisis warning signs and immediate danger
25:17 How to ask directly about suicide
27:09 Supporting a loved one and creating a safety plan
29:00 Practical next steps and realistic hope
30:36 Three rapid-fire questions
31:34 One-year anniversary reflections
36:29 Dr. Blairâs practice information
37:15 Key takeaways and weekly kindness challenge
38:48 KindnessRX support groups and closing
ABOUT DR. MARK BLAIR
Mark E. Blair, M.D., is a board-certified psychiatrist and founder and medical director of Optimum Wellness & TMS in Columbus, Ohio.
Optimum Wellness & TMS
500 E Main Street, Suites 110 & 130
Columbus, OH 43215
Phone: 614-933-4200
Email: [email protected]
Website: https://www.optimumwellnessandtms.com
New patients: https://www.optimumwellnessandtms.com/two-ways-to-begin
SAFETY-PLAN RESOURCES
Create an interactive safety plan:
https://www.mysafetyplan.org/
Download a blank safety-plan PDF:
https://www.mysafetyplan.org/static/NationalSPA-f57dd48ae60b5b1e9c5a1a980a978693.pdf
LEARN MORE
NIMH brain-stimulation therapies:
https://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies
Official BrainsWay information:
https://www.brainsway.com/
Official Spravato information:
https://www.spravato.com/
KINDNESSRX
Website:
https://kindnessrx.org/
Free online peer-led support groups:
https://kindnessrx.org/groups
KindnessRX groups provide peer support and do not replace therapy, medical care, professional advice, or crisis services.
Read the complete companion article, treatment information, safety-plan resources, and further reading:https://kindnessrx.org/when-depression-doesnt-lift
DISCLAIMER
This episode is for general education only and is not individual medical advice.
Treatment decisions should be made with a qualified healthcare professional who can consider your diagnosis, medical history, prior treatment, risks, benefits, and alternatives.
IV ketamine for depression is an off-label use. No treatment is guaranteed to work.