What to know first
- Advanced care begins with a careful evaluation, not an automatic move to TMS, SPRAVATO, ketamine, or ECT.
- A specialist should review diagnosis, prior treatment, safety, medical contributors, goals, and practical access barriers.
- Crisis or emergency needs should not wait for a specialty appointment or online directory.
Reasons to ask for a deeper evaluation
Consider discussing advanced care when the current plan is not enough.
There is no single symptom count or treatment number that tells everyone when to see a specialist. The decision depends on severity, safety, daily function, diagnosis, prior care, side effects, preferences, and access.
- Depression symptoms continue to disrupt work, school, relationships, sleep, eating, or basic daily responsibilities despite treatment.
- One or more treatment attempts have not helped enough, stopped helping, caused difficult side effects, or could not be completed.
- The diagnosis or treatment history is unclear, especially when bipolar symptoms, trauma, anxiety, substance use, sleep problems, pain, or another medical condition may be involved.
- A clinician has raised TMS, SPRAVATO/esketamine, ketamine, ECT, a higher level of care, or another treatment that needs specialized evaluation and monitoring.
- Care is fragmented across multiple clinicians and no one is clearly coordinating diagnosis, medication, psychotherapy, safety planning, and follow-up.
These are prompts for a clinician conversation, not a way to diagnose yourself or decide which treatment to receive. A primary-care clinician, psychiatrist, or current therapist can help determine whether a specialty consultation is appropriate and how urgently it is needed.
What “advanced” should mean
Look for a broader assessment—not simply access to a procedure.
A strong evaluation should clarify the clinical picture before a center recommends a device, medication, infusion, or procedure.
Diagnosis and safety
The clinician should review depression severity, bipolar or psychotic symptoms, substance use, current safety, and whether a different level of care is needed.
Prior treatment
Medication names, doses, duration, benefit, side effects, psychotherapy, hospital care, and previous advanced treatments should be reviewed in context.
Medical contributors
Sleep problems, pain, medications, hormonal or thyroid concerns, neurologic illness, and other health conditions may affect mood and treatment planning.
Responsibility and follow-up
Ask who owns the overall plan, coordinates with existing clinicians, measures progress, handles side effects, and responds when symptoms worsen.
Before choosing a center
Compare the pathway and the clinical responsibility.
Treatment options differ in regulatory status, setting, schedule, monitoring, transportation needs, insurance requirements, and known risks. Advertising or availability alone cannot establish that a treatment fits your diagnosis or circumstances.
Prepare for the conversation
Bring a short record and ask who is responsible for each step.
Write down prior treatments, approximate doses and durations, benefits, side effects, and reasons for stopping. Bring the information directly to an appropriate clinician; do not submit symptoms, medication history, or crisis details through this public website.
Open the appointment question checklist →Authoritative sources
Review public guidance directly
This page provides general education. It does not diagnose, recommend a personal treatment, or replace care from a qualified clinician.