Up to 30% of people diagnosed with major depressive disorder are treatment-resistant. That means they’ve tried at least two conventional antidepressants but didn’t feel any better.
If you’re in that group, you’ve probably spent a considerable amount of money trying to figure out what works for you. While some of the expenses are from direct costs like hospital and/or doctor visits and medications, they aren’t the only ones, says Vaughn McCall, MD, a psychiatrist and professor emeritus at the Medical College of Georgia.
“There are also more indirect costs, such as missed time from work,” McCall says. “There are also costs that don’t have any financial value but are also important. They include broken relationships and worse physical health because you don’t take care of yourself.”
McCall addressed this and more during WebMD’s recent Reddit AMA on treatment-resistant depression (TRD). Here’s a closer look at the financial impact of TRD, along with tips on how to get the care you need without emptying your wallet.
By the Numbers
A data analysis comparing the health care costs of people with TRD to those with non-TRD found that the former spent almost $1,800 in the first year of treatment and about $1,500 the second year. Almost $700 more total.
TRD is pricier for several reasons:
More hospital visits. People with TRD have 235% more hospital visits than people who don’t have it. They also have 128% more ER visits. You’ll have to spend money on deductibles and copays, even if you do have health insurance.
More doctor visits. People with TRD are 155% more likely to see a medical professional than someone without depression. They’re also more at risk for other health conditions, such as heart or lung disease. These costs add up over time. “You also have to factor in time taken off from work and money spent on transportation and travel time,” says McCall. “Those are all hidden but real costs.”
Psychotherapy. Talk therapy has been shown to help TRD. But it can be out of reach for some people, especially if you don’t have health insurance. Sessions typically range from $70 to $150 out of pocket, depending on the state you live in. Federal law requires all health insurance plans to cover mental health care, but you still might have to pay a copay or meet your deductible first.
Newer or nonconventional treatments. There are some therapies insurance won’t cover. Or they’ll require you to try less expensive options first, like multiple antidepressants. Your doctor may recommend transcranial magnetic stimulation (TMS), which uses magnetic fields to stimulate nerve cells in the brain. Most insurers cover some portion, but if you’re not insured, the out-of-pocket cost could be anywhere from $6,000-$12,000.
Lost income. People with TRD lose almost 36 days of work each year. That’s almost twice the rate of people with non-TRD and more than six times that of people who don’t have any form of depression. “When you are at work, you’re more likely to be less productive, because of your mood,” McCall says. “You may be less likely to advance in your job, or even lose it entirely.”
How to Spend Less
Despite the costs, treatment is essential when you have depression — especially TRD.
“People with TRD have a higher risk of suicide,” says Mark Rapaport, MD, president-elect of the American Psychiatric Association. “It can impact their work, and their relationships with loved ones and friends. It’s hard to be present in all aspects of your life when you grapple with TRD.”
All the more reason to continue looking for affordable ways to get the care you need. Consider these tips to rein in health care costs:
Save money with generics and coupons
Try more nonbranded options. These have the same active ingredient as the brand-name version of a drug and cost less. People with TRD should’ve tried at least two generic antidepressants, McCall says. If those didn’t work, other low-cost generics are available. Ask your doctor about adding a second antidepressant from a different class, like bupropion (Wellbutrin) or mirtazapine (Remeron). Or a low dose second-generation antipsychotic such as aripiprazole (Abilify) or brexpiprazole (Rexulti).
Use coupons for newer medications. Dextromethorphan/bupropion (Auvelity) was FDA approved to treat depression in 2022. Dextromethorphan is the ingredient in many over-the-counter cough medications. “It targets the NMDA receptor in your brain, rather than serotonin or norepinephrine like other traditional antidepressants,” McCall says. In two long-term studies, the response rate was more than 80%, and about 70% of users saw their depression symptoms disappear entirely.
A generic version of Auvelity isn’t available. But the company does offer a savings program for eligible patients. You could pay as little as $10 for a 90-day supply.
Esketamine (Spravato) may be another option. Approved in 2019 to treat TRD, this nasal spray also targets NMDA. The company offers patient assistance programs.
Try nondrug therapies. Treatments such as electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) are often covered by insurance and are very effective, Rapaport says. ECT involves passing an electric current through your brain, and TMS involves placing a device against the scalp to pass magnetic waves into your brain.
These treatments can be very time intensive, which is why many people are reluctant to do them, Rapaport says. ECT, for example, may require six to 12 sessions that are done three times a week. TMS is also often done daily for four to six weeks.
“You have to take time off of work and away from family in the short term, which may cost you financially,” Rapaport says. “But you need to view these treatments as investments. Yes, you may have to set aside some money and time for now, but it’s worth it if it treats your depression so you can be much more productive and have more success in all aspects of your life.”
Look for low-cost therapy
Ask your therapist if they offer services on a sliding scale. A type of talk therapy called cognitive behavior therapy (CBT) is very effective for TRD, McCall says. But it can become expensive over time. With a sliding scale, the rate you pay is based on your income.
Find a federally qualified health center. They often offer affordable mental health services. You can use their health center locator tool to find a center near you.
Go to a university clinic. You may be able to work with a graduate student (who is supervised by an instructor) at a lower cost.
Consider teletherapy. It may be less expensive than in-person therapy, and it’s often covered by insurance. “It also requires less travel time, which means less time off of work, and means you don’t have to spend money on child care since you can do it from home,” McCall says.
Lifestyle Changes That May Help Cut Costs
Self-care is an important tool to help you manage TRD. “It’s a low-cost way to reduce stress and regulate your mood,” McCall says. Some strategies he recommends include:
Exercise regularly. Exercise may be as effective as talk therapy or medication for treating depression, according to a 2026 review of over 70 studies published in the Cochrane Database of Systematic Reviews. The review also noted that many of these studies were small, and more research is needed to confirm these effects. “You don’t even have to join a gym — just a short walk has benefits,” McCall says.
Eat healthy foods. A small 2026 JAMA Psychiatry study found that a six-week ketogenic diet significantly improved symptoms in TRD compared to a control diet. A ketogenic diet is a high-fat, low-carbohydrate eating habit that can be challenging to stick to, however. Other research shows that a Mediterranean-style diet — an eating pattern rich in fruits, veggies, whole grains, beans, seafood, and healthy fats like olive oil — reduces symptoms of depression and anxiety.
Limit alcohol, cigarettes, and marijuana use. If you rely on alcohol or marijuana to manage symptoms of depression, talk to your doctor about getting help. Substance use disorder is linked to TRD.
Stay social. It can be hard to motivate yourself to connect with others when you have TRD. But it’s important. “Social support can help to reduce symptoms of depression,” McCall says. “It’s easy to want to hole up and isolate, but that can lead you to ruminate and make you feel worse.”
Download a mental health app. They have been shown to help treat symptoms of moderate to severe depression, according to a 2023 study published in JAMA Network Open. You can search for apps on the M-Health Index and Navigation Database (MIND).
All these steps together may seem daunting. Pick one healthy lifestyle habit at a time to adopt. Start slow and go easy.
“Be gentle with yourself,” Rapaport says. “If you went for a walk once this week, aim to do it twice next week. Once you start to invest in these treatments, you’ll start to feel better, which will empower you and make you feel like you can handle more. View it as the ultimate investment in yourself.”
Show Sources
Photo Credit: E+/Getty Images
SOURCES:
Vaughn McCall, MD, psychiatrist; professor, Medical College of Georgia.
Mark Rapaport, MD, president-elect, American Psychiatric Association; CEO, Huntsman Mental Health Institute, University of Utah Health.
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