Reviewed by: Assel Omarova, MD, psychiatrist and addiction specialist · updated 6 Nov 2026
Key facts
- Who conducts it
- a psychiatrist experienced in managing complex cases
- Format
- online review of records, video consultations, in-person tests when indicated
- Duration
- the review takes 1–2 appointments; treatment lasts months with regular assessment
- Anonymity
- confidential; information is protected by medical confidentiality
- When it's urgent
- suicidal thoughts, refusing food and drink, psychosis — call 103 or 112
- Outcome
- a clarified diagnosis, a new treatment strategy, and a follow-up plan
What you should know
The term “treatment-resistant depression” is used in psychiatry for cases in which consistent treatment does not lead to remission. The most widely used definition refers to an insufficient response to two courses of antidepressants given at an adequate dosage and for an adequate length of time. According to international research, this situation affects a notable share of patients with depression — and it does not mean that nothing can be done. Treatment for resistant depression in Zhezkazgan begins with analyzing why previous treatment did not work.
It is important to distinguish true resistance from pseudo-resistance. In the latter, the lack of effect is due to a course that was too short, irregular use of medication, an incorrect diagnosis, an overlooked co-occurring disorder, or a physical cause. According to clinical guidelines, pseudo-resistance is quite common. That is why the first step is a careful review of your treatment history rather than automatically prescribing new medications.
Signs That Depression May Be Treatment-Resistant
- two or more courses of antidepressants have not brought significant improvement
- improvement was only partial, and residual symptoms persist for months
- depressive episodes keep recurring despite maintenance treatment
- each new medication helps for a short time, and then the effect wears off
- treatment has been interrupted because of side effects, narrowing the choice of medications
- depression occurs together with anxiety, insomnia, or chronic pain
- a long-lasting condition is accompanied by a loss of hope of recovery
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 Treatment May Not Work
Causes of pseudo-resistance include a course that was too short, missed doses, drug interactions, and rapid metabolism of medications. An inaccurate diagnosis plays an important role too: bipolar depression, in which standard antidepressants are not very effective; undiagnosed anxiety disorders; the aftermath of psychological trauma; and personality disorders. Co-occurring alcohol misuse also substantially reduces the response to treatment.
Physical causes — hypothyroidism, anemia, nutritional deficiencies, chronic inflammatory diseases, neurological disorders, and obstructive sleep apnea — can sustain depressive symptoms. Social factors matter as well: ongoing stress, isolation, and chronic conflict. True resistance is linked to the individual neurobiology of a particular person and calls for the special strategies described in clinical guidelines.
How Online Treatment Is Organized
Before the consultation, the patient sends discharge summaries, a list of all medications taken previously with the duration and effect of each course, and test results. During the video appointment, the psychiatrist takes the history afresh, asks about episodes of elevated mood, traumatic experiences, and substance use, and assesses severity using rating scales. The result is a hypothesis about why treatment has not worked and a plan: further tests, treatment adjustments, and psychotherapy. Follow-up continues through regular video appointments.
Some stages require in-person participation: lab tests, an ECG, consultations with an endocrinologist and neurologist, and a sleep study. Certain treatments for resistant depression, such as neuromodulation, are provided only in specialized facilities. If you have suicidal thoughts, refuse food, or have psychotic symptoms, call 103 or 112; young people can also call 150. Prescribing prescription medications is governed by the laws of the Republic of Kazakhstan.
How we help
Reviewing the diagnosis and treatment
The psychiatrist analyzes whether previous courses matched the recommended duration and dosage, whether medications were taken regularly, and whether there were any interactions. Differential diagnosis is carried out to rule out bipolar disorder, anxiety disorders, and the effects of trauma. It often turns out at this stage that what is needed is not a new medication but a different strategy.
Optimization and augmentation strategies
Clinical guidelines describe a sequence of steps: optimizing current treatment, switching to a medication with a different mechanism of action, combining antidepressants, and adding augmenting agents from other drug classes. The choice is made individually, taking tolerability and co-occurring conditions into account, and the effect is assessed against criteria agreed in advance.
Psychotherapy
Adding psychotherapy increases the likelihood of a response in resistant depression. Approaches include cognitive behavioral therapy, including its versions for chronic depression, mindfulness-based therapy, and interpersonal therapy. Online sessions make it possible to keep up a regular schedule even when energy is low and leaving the house is difficult.
Referral for specialized treatments
When medication and psychotherapy have not worked, treatments offered in specialized facilities are considered: transcranial magnetic stimulation, electroconvulsive therapy under anesthesia, and others. Online treatment for resistant depression in Zhezkazgan at Psychiatry Online includes preparation for this stage, a discussion of benefits and risks, and follow-up afterward.
Myths and facts
MythTreatment-resistant depression is incurable
FactResistance only means that the standard first steps did not help. Using other strategies, psychotherapy, and specialized treatments in sequence brings improvement for many patients, even if the path is longer.
MythIf a medication doesn't work, you should raise the dose yourself
FactChanging the dose on your own is dangerous because of the risk of side effects and interactions. Treatment should be adjusted by a doctor, who considers the length of the course, tolerability, and other factors the patient may not be aware of.
MythElectroconvulsive therapy is an outdated and cruel method
FactModern ECT is performed under general anesthesia with muscle relaxation, for strict indications, and with the patient's consent. International guidelines consider it an effective treatment for severe and treatment-resistant depression.
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 Zhezkazgan
| 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
You can book in Zhezkazgan online or at one of two branches: 65 Esenberlina St., office 30, Zhezkazgan, 81 Gagarina St., office 20, Zhezkazgan. Our coordinator replies on WhatsApp within minutes at any time, and a doctor usually connects by video the same day; home visits are available too — all city districts and nearby settlements.
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
When is depression considered treatment-resistant?
Usually when two courses of antidepressants from different classes, given at an adequate dosage and for an adequate duration, have not brought significant improvement. Before speaking of resistance, the doctor checks whether these conditions were met and whether the diagnosis is correct.
Do I need to repeat lab tests?
Often, yes: to rule out physical causes of depression, it is recommended to check thyroid function, blood counts, and other parameters as prescribed by the doctor. The tests are done in person, and the results are discussed during a video consultation.
Could an incorrect diagnosis be the cause?
Yes, it is one of the most common reasons treatment appears not to work. For example, depression as part of bipolar disorder requires a different approach than recurrent depression. Repeat diagnosis with a detailed history helps identify such situations.
Does psychotherapy help if pills haven't?
Yes, adding psychotherapy increases the likelihood of improvement in resistant depression. Approaches developed specifically for chronic depression are especially useful. The online format makes it easier to attend sessions regularly even when your energy is low.
What should I do if I feel there's no hope left?
A sense of hopelessness is a common symptom of long-lasting depression, not an objective assessment of your prospects. If you have thoughts of suicide, call 103 or 112; young people can also call the 150 helpline. See a psychiatrist to have your treatment reviewed.
Can I get a second opinion on resistant depression?
Yes, a second opinion is especially valuable when treatment has been ineffective for a long time. The psychiatrist will review the history of your treatment courses and suggest alternatives. Treatment for resistant depression in Zhezkazgan can then continue with your current doctor, taking these recommendations into account.
Where can I be seen in Zhezkazgan?
Online — from anywhere in the city or region. In person — at two branches: 65 Esenberlina St., office 30, Zhezkazgan and 81 Gagarina St., office 20, Zhezkazgan. 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
