Reviewed by: Assel Omarova, MD, psychiatrist and addiction specialist · updated 6 Nov 2026
Key facts
- Who leads the session
- a psychiatrist experienced in complex and treatment-resistant conditions
- Format
- video consultations with documents reviewed in advance; in-person steps when needed
- Duration
- initial review 60–90 minutes; follow-ups every 2–4 weeks for several months
- Anonymity
- consultations without your surname; documents can be submitted with personal details blacked out
- When it is urgent
- suicidal thoughts, refusal to eat or drink, psychotic symptoms—call 103 or 112
- Outcome
- a clarified diagnosis, an analysis of why treatment failed, and a step-by-step plan for switching and augmenting therapy
What you should know
What does “treatment-resistant” mean? The term is used when depression does not respond to two or more adequate courses of antidepressants. The key word is “adequate”: in clinical practice, a large share of “resistance” turns out to be pseudo-resistance, when the medication was taken for too short a time, at too low a dose, irregularly, or for the wrong disorder. That is why the first step is not a new medication but a thorough review of everything that has been done.
Treatment-resistant depression is not a life sentence. Clinical guidelines describe step-by-step strategies, and most patients improve with a structured approach. The online format is well suited to this work: it requires regular monitoring, and traveling to a clinic is especially hard during prolonged depression. Residents of the Saryarka or Baikonur districts do not have to cross the whole city in freezing weather for the doctor to assess their progress.
When Depression Can Be Considered Treatment-Resistant
- two or more courses of antidepressants from different drug classes have not led to noticeable improvement
- you get a partial response, but residual symptoms persist for months
- your depression has lasted more than a year despite regular treatment
- episodes keep coming back, and each one is harder to treat than the last
- treatment was stopped because of side effects before it had a chance to work
- you also have anxiety, an addiction, or chronic pain
- you feel that “nothing will help anymore” and are losing heart
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 Does Not Respond to Treatment
The most common causes of pseudo-resistance are an incorrect diagnosis and inadequate treatment. Bipolar disorder in a depressive phase responds poorly to antidepressants given without mood stabilizers; depression may also be secondary to an anxiety disorder, ADHD, an addiction, or a personality disorder. Overlooked physical conditions—hypothyroidism, anemia, chronic inflammatory diseases, sleep apnea—also reduce the response to treatment.
True resistance is linked to biological factors: genetic differences in how drugs are metabolized, changes in inflammatory and neuroplastic mechanisms, and disrupted circadian rhythms. It is sustained by chronic stress, social isolation, sleep deprivation, and alcohol. During the long winter with short daylight hours, some people also have a seasonal component that requires separate measures.
How Treatment-Resistant Depression Is Managed Online
In advance, you send your medical records and a list of all the medications you have taken, with the periods of use, their effect, and any side effects. The doctor organizes your history and, during the video appointment, re-evaluates the diagnosis: clarifying any episodes of elevated mood, substance use, co-occurring disorders, and sleep. Lab tests are recommended to rule out physical causes. A step-by-step plan is then drawn up, with clear timelines for assessing each step.
Some treatments for resistant depression—transcranial magnetic stimulation, electroconvulsive therapy, and certain types of infusion therapy—are provided only in person at specialized facilities. Prescribing prescription medications depends on Kazakhstan law. With a high suicide risk or a severe condition, inpatient care is needed; if there is a threat to life, call 103 or 112.
How we help
Reviewing the diagnosis and treatment history
The doctor checks whether each course was adequate in duration and dose, whether the medications were taken regularly, and whether there were any interactions. The diagnosis is re-evaluated against ICD-10/ICD-11 criteria, ruling out bipolar disorder, co-occurring disorders, and physical causes. Often, a specific reason for the failure is found at this stage, and treatment starts to work.
Optimizing, switching, and augmenting
Clinical guidelines offer several strategies: optimizing the dose within the approved labeling, switching to an antidepressant with a different mechanism, combining two antidepressants, or augmenting with medications from other classes—for example, certain mood stabilizers or atypical antipsychotics. Each step is assessed after a pre-agreed period so you do not stay stuck on a regimen that is not working.
Psychotherapy
Adding psychotherapy to medication improves outcomes in treatment-resistant depression. Approaches include cognitive behavioral therapy, mindfulness-based therapy, and specialized programs for chronic depression. Psychotherapy helps address hopelessness, avoidance, and interpersonal factors that keep depression going and interfere with the effect of medication.
Non-drug methods
When the effect is insufficient, neuromodulation methods—TMS and ECT—are considered, as well as light therapy if there is a seasonal component. Online, the doctor assesses whether you are a candidate, explains the mechanism, risks, and benefits of each method, and refers you to a facility that provides it. After the course, follow-up can continue online with Psychiatry Online without losing continuity of care.
Myths and facts
MythIf two medications didn’t help, nothing will
FactResistance to two courses is a reason to change strategy, not to stop treatment. There are augmentation and combination strategies, psychotherapy, and neuromodulation methods, and with a consistent approach many patients improve.
MythTreatment-resistant depression is a special, incurable form
FactA large share of cases are pseudo-resistance due to an incorrect diagnosis or inadequate treatment. Even true resistance responds to treatment, although the road to remission can be longer and requires patience.
MythECT is a dangerous and outdated method
FactModern electroconvulsive therapy is performed under general anesthesia for strict indications and remains one of the most effective treatments for severe treatment-resistant depression. The doctor discusses the risks and benefits with each patient individually.
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 Astana
| 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
Psychiatry Online in Astana: same-day video appointments and two branches for in-person visits — 72 Bogenbay batyra St., Astana and 37 Petrova St., office 23, Astana. Our mobile team works around the clock: all city districts and nearby settlements. If you live elsewhere in Astana and Akmola Region, starting online is usually easiest.
Confidential and private
Information about your visit, diagnosis and treatment is protected by medical confidentiality under the Code of the Republic of Kazakhstan “On Public Health and the Healthcare System”. We never share it with your employer, school or relatives without your consent; the only exceptions are those expressly set out by law. For an online consultation your first name is enough, video runs over a secure channel and nothing is recorded without your consent.
Questions and answers
How can I tell if I have treatment-resistant depression?
If two courses of antidepressants from different classes, taken at an adequate dose and for long enough, have not led to significant improvement. But before talking about resistance, the doctor checks the diagnosis, whether the medication was taken regularly, and possible physical causes. Many cases become clear at this stage.
What should I prepare for the consultation?
Medical records, specialist reports, a list of all medications with approximate periods of use and dose levels, the effect and side effects of each, and your test results. It also helps to describe the timeline of your episodes and periods of improvement. The more complete your history, the more accurate the analysis.
Can treatment-resistant depression be treated entirely online?
Much of it, yes: diagnosis, review of your history, selection and monitoring of medication, and psychotherapy. Neuromodulation methods and some procedures are done in person. Lab tests are done at a laboratory with a referral, and the results are discussed at a video appointment.
How long will it take to find an effective treatment?
Each step is assessed after several weeks, so the process may take several months. That does not mean nothing changes during all that time: the first steps often bring partial improvement, and psychotherapy helps you cope with the waiting period.
Does winter affect treatment-resistant depression?
Some patients have a seasonal component: their deterioration predictably falls during the period of short daylight hours. In that case, light therapy and routine adjustments are added to the main treatment, and the treatment plan takes the season into account. The doctor will help identify this pattern from your history of episodes.
What should I do if I feel hopeless and have thoughts of death?
This is a common experience in prolonged depression, but it does not mean there is no way out. Be sure to tell your doctor about it. If you intend to harm yourself, call 103 or 112 immediately; teenagers and young people can call the 150 helpline.
Where can I be seen in Astana?
Online — from anywhere in the city or region. In person — at two branches: 72 Bogenbay batyra St., Astana and 37 Petrova St., office 23, Astana. 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
