1. Start with the timeline
What has been tried—and what actually happened?
For each medication, write the name, highest remembered dose, approximate duration, benefit, side effects, and why it stopped. Add psychotherapy, hospital treatment, TMS, SPRAVATO/esketamine, ketamine, ECT, or other care. “It failed” is less useful than a short description of response and barriers.
Medication or treatment:
Dose / frequency / duration:
Benefit:
Side effects or barriers:
Why it changed or stopped:
2. Ask what needs reassessment
A different diagnosis or contributing condition can change the plan.
- Could bipolar symptoms, trauma, anxiety, substance use, grief, or another condition be part of the picture?
- Could sleep apnea, thyroid disease, pain, medication effects, hormonal factors, or neurologic illness be affecting mood?
- Were prior medication trials adequate in dose and duration?
- Was psychotherapy accessible and matched to the diagnosis and goals?
- What current safety concerns change the urgency or setting of care?
3. Compare the pathway, not the promise
Every option has a setting, schedule, monitoring plan, and reason it may or may not fit.
Medication strategies
Ask whether the goal is to optimize, switch, combine, or augment, why that strategy fits, and how benefit and safety will be monitored.
TMS
Ask about device, protocol, indication, treatment frequency, safety review, progress measurement, and insurance.
SPRAVATO / esketamine
Ask about REMS certification, onsite administration, monitoring, transportation, other medications, cost, and follow-up.
Ketamine
Ask which product and route are used, whether use is off label or compounded, who monitors treatment, and how ongoing need is assessed.
ECT
Ask why it is being considered now, anesthesia and medical evaluation, memory effects, treatment schedule, and maintenance planning.
4. Bring practical questions
Care has to fit real life.
- How many visits are required, and over what period?
- Will I need transportation or time away from work or caregiving?
- What does insurance require before authorization?
- What is the full expected cost, including evaluation and follow-up?
- How will progress and adverse effects be measured?
- What happens if the first advanced treatment does not help enough?
- Who do I contact if symptoms worsen between visits?
Authoritative sources
Use current public guidance
Continue
Use the treatment center checklist next.
Bring a short list of questions about supervision, services, monitoring, insurance, availability, and urgent support.
Open the center checklist