Reviewed by: Assel Omarova, MD, psychiatrist and addiction specialist · updated 6 Nov 2026
Key facts
- ICD-10 code
- F33
- Who you see
- a psychiatrist experienced in treating complex and long-lasting depression
- Format
- document review and video consultations, ongoing online follow-up
- Duration
- first appointment 60–70 minutes, check-ins every 1–3 weeks
- Anonymity
- treatment is confidential, with no registration on any registry
- When it is urgent
- suicidal thoughts, refusing food and drink — call 103 or 112; young people can also call 150
- Outcome
- a revised diagnosis and a treatment strategy with clear stages
What you should know
When depression does not lift after several courses of treatment, it is easy to conclude that nothing can help. That is not true. Treatment resistance is a well-known phenomenon that psychiatrists address according to international clinical guidelines. It often turns out that the “ineffective treatment” was too short, the dose was too low, the medications were all from the same class, or a coexisting problem was not taken into account: anxiety, alcohol, hypothyroidism, chronic stress or sleep disorders.
The first step is a thorough review of what has already been done. Online, this is convenient: you send your discharge summaries and medication list, and a Psychiatry Online doctor reviews them before the appointment. There is no need to carry a stack of documents from Auezov district to central Almaty and retell your story in a hurry. On the video call the psychiatrist clarifies the details, re-examines the diagnosis and suggests an updated strategy: switching to a different class, combination therapy, adding psychotherapy, or referral for treatments that are delivered in person.
When depression is considered difficult to treat
- two or more courses of antidepressants have not brought noticeable improvement
- improvement has been partial: things are easier, but you still cannot live a full life
- depression keeps coming back despite maintenance therapy
- every new medication causes side effects, and the courses keep being cut short
- besides depression, there is anxiety, alcohol use, chronic pain or insomnia
- treatment was prescribed without a thorough assessment or a review of the diagnosis
- you have lost hope and believe that “nothing will help anymore”
If at least two points apply and the state lasts longer than two weeks, it is worth seeing a specialist. Phone consultation is free. If life is at risk, call 112 or 103.
Why depression may not respond to treatment
Some cases of “resistance” are actually pseudo-resistance: the medication was taken irregularly, for too short a time, at too low a dose, or was stopped because of side effects before it had a chance to work. Sometimes the diagnosis needs refining — for example, bipolar depression responds poorly to standard antidepressants and requires a different approach. Physical illnesses, drug interactions and alcohol use can also play a role.
Psychological and social factors matter too. An ongoing conflict, a difficult situation at work, caring for a sick relative or loneliness in a big city can keep depression going even if the medication has been chosen correctly. Chronic sleep deprivation, typical of big-city life where the day starts in traffic and ends late in the evening, weakens the effect of therapy. That is why treatment for treatment-resistant depression almost always has to be comprehensive.
How online care for treatment-resistant depression works
You message us on WhatsApp → receive a list of documents to gather: discharge summaries, the names of all medications with dates and duration, side effects and test results. You send them before the appointment. The doctor reviews your history and, on the video call, clarifies exactly how the medications were taken, what helped even partially and which circumstances got in the way. At the end you receive a plan: what to change first, which tests to take and when the next appointment is.
Some treatments for treatment-resistant depression are delivered only in person: transcranial magnetic stimulation, electroconvulsive therapy and certain medications given under supervision in a medical facility. The online doctor will help you understand whether they are indicated and tell you where to go. Medications are prescribed in accordance with the laws of Kazakhstan. If you have suicidal thoughts, call 103 or 112.
How we help
Review of previous treatment
The psychiatrist reconstructs the timeline: which medications were taken, in what order, for how long and with what effect. They check whether the courses were adequate in duration and intensity and whether any side effects or interactions were missed. This review alone sometimes shows that treatment options have not been exhausted and that there are clear steps forward.
Re-examining the diagnosis
The doctor reassesses the overall picture: are there signs of bipolar disorder, an anxiety disorder, a personality disorder, addiction or physical causes? A referral for tests may be needed — thyroid hormones, vitamins, a complete blood count. A refined diagnosis often changes the treatment strategy and opens up options that had not been considered before.
Medication strategies
International guidelines describe several paths when the response is insufficient: switching to a medication from a different class, combining medications, or augmenting with a drug from another class. The choice depends on your symptoms, tolerability and previous experience. The psychiatrist explains the reasoning behind each step, and changes are made gradually while monitoring how you feel.
Psychotherapy and support
In treatment-resistant depression psychotherapy is especially important: it helps address chronic stress, rumination, relationships and a sense of hopelessness. At Psychiatry Online, a psychotherapist joins online and works hand in hand with the psychiatrist. Sleep routine, physical activity and avoiding alcohol are also discussed, as they enhance the effect of treatment.
Myths and facts
MythIf treatment has failed twice, nothing can help
FactTreatment-resistant depression is a reason to rethink the approach, not a life sentence. There are several sequential strategies, including switching medication classes, combinations, psychotherapy and non-drug treatments, and many patients do improve.
MythYou just need to find a “strong” medication
FactIt is not about strength but about matching the treatment to the specific situation. Sometimes the key lies in refining the diagnosis, addressing a physical cause or working on life circumstances. That is why a comprehensive review matters more than searching for a miracle pill.
MythComplex depression cannot be managed online
FactReviewing treatment history, assessing symptoms and adjusting therapy can all be done fully via video call. Certain treatments and tests are carried out in person, and the doctor will tell you honestly when they are needed and where to go.
How an online appointment works
- Message or callWrite on WhatsApp or call — our coordinator replies within minutes, day or night. You don't have to give your surname.
- Doctor and timeWe match you with a psychiatrist, addiction specialist or psychotherapist and agree on a time — often the same day.
- Video consultationA secure 50–60 minute video call: the doctor takes a detailed history and uses standardised scales if needed.
- Treatment planYou receive a clear summary, recommendations and a plan: what we do online and what needs an in-person visit or home call.
- Follow-upOnline follow-up sessions, messenger contact with your doctor, and treatment adjustments until you get a stable result.
Prices in Almaty
| Online psychiatrist consultation (50–60 min) | 15 000 ₸ |
| Follow-up online consultation | 12 000 ₸ |
| One month of online psychiatric care | 60 000 ₸ |
The final cost is agreed before treatment starts. Prices are in tenge and do not constitute a public offer.
Where to get help
An online consultation for “Treatment-resistant depression” is available to people across Almaty and Almaty Region 24/7 — from home, work or while travelling. For an in-person visit, Psychiatry Online in Almaty has two branches: 129 Kurmangazy St., office 8, Almaty and 110 Bogenbay batyra St., office 15, Almaty. Doctor home visits: all city districts and nearby settlements.
Confidential and private
An online appointment in Almaty is first of all about privacy: no clinic visit, no waiting room. A private room and headphones are enough. Data is stored in a secure system with restricted access and does not enter any state registry without legal grounds.
Questions and answers
How can I tell whether my depression is treatment-resistant?
Depression is usually called treatment-resistant if two adequate courses of antidepressants from different classes have not had a sufficient effect. But often the cause is that the courses were too short or doses were missed. The psychiatrist will go through your history and tell you whether it really is treatment resistance.
How long does it take to find a treatment that works?
Each new step is usually evaluated after several weeks. That is why finding the right strategy may take several months. Regular online appointments help you avoid losing time and move on to the next step promptly if the current one is not working.
What tests might be needed?
Commonly ordered tests include a complete blood count, thyroid hormones, vitamin D and B12 levels and a metabolic panel. Sometimes consultations with a neurologist or endocrinologist are needed. You can have the tests done at any lab in Almaty near your home and send the results to your doctor via messenger.
Does TMS help with treatment-resistant depression?
Transcranial magnetic stimulation is included in international guidelines as one of the options when there is an insufficient response to antidepressants. It is delivered only in person, as a course. The online psychiatrist will help you understand whether this method suits you and tell you where you can have it.
Can I combine treatment with you and follow-up with my previous doctor?
Yes, but it is important that decisions about therapy are coordinated. Many patients use the consultation as a second opinion and then discuss the suggestions with their treating doctor. The main thing is not to change your treatment regimen on your own. That is safer.
What should I do if I have lost hope?
Hopelessness is one of the symptoms of depression, not an objective assessment of your situation. Tell your doctor about it. If you have suicidal thoughts, call 103 or 112 immediately; young people can contact the 150 helpline. Do not stay alone with these thoughts.
Where can I be seen in Almaty?
Online — from anywhere in the city or region. In person — at two branches: 129 Kurmangazy St., office 8, Almaty and 110 Bogenbay batyra St., office 15, Almaty. Both are open 24/7; home visits cover all city districts and nearby settlements.
Sources and methodology
This page was prepared by the Psychiatry Online medical editorial team based on:
- International Classification of Diseases ICD-10 and ICD-11, World Health Organization
- Clinical diagnosis and treatment protocols of the Ministry of Health of the Republic of Kazakhstan
- Code of the Republic of Kazakhstan “On Public Health and the Healthcare System”
- NICE (UK) and APA (US) guidelines on the treatment of mental disorders
- WHO recommendations on telemedicine and digital health
This information is for reference only and does not replace a consultation with a specialist. Editorial policy
