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Treatment-Resistant Depression
When Depression Hasn’t Improved Enough
Dr Charles does not recommend that you determine your own diagnosis or start treatment yourself. This information is here so you can have a better-informed conversation with your doctor, who can refer you if a psychiatric opinion would help.
To be considered for TMS Therapy you need a referral first, from your GP, psychologist, or another doctor. Once a referral is received, Dr Charles reviews it and, where appropriate, offers an appointment.
What does "treatment-resistant" mean?
"Treatment-resistant depression" is a term psychiatrists use when depression does not respond adequately to two or more trials of appropriate antidepressant treatment at adequate doses, for an adequate duration.
It is not a separate diagnosis in the sense of a different illness, it describes a situation where depression has been harder to treat. It is also not a judgement on the person: many people with treatment-resistant depression go on to find an approach that helps them. Whether this applies to you is a clinical judgement, made by a psychiatrist
Why a psychiatric reassessment can help
When depression has not improved adequately, a reassessment looks beyond the original diagnosis to understand why. A reassessment typically includes:
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a careful review of your symptoms, diagnosis and treatment history;
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a review of past and current medication : doses, how long each was used, and why it was changed or stopped;
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whether factors such as side effects, adherence, or other conditions (comorbidities) are affecting response;
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whether any additional support such as psychotherapy has been or should be part of the picture;
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and, where relevant, whether a non-invasive treatment such as TMS might be considered.
The purpose is not to recommend a specific treatment, but to understand what may be contributing to the lack of improvement and to agree on the most appropriate next step with you.
Possible next steps
Changes to medication such as a different antidepressant, a different dose, or a combination, based on your history;
Psychotherapy: including approaches for depression that has not responded well to medication alone.
Transcranial magnetic stimulation (TMS) : a non-invasive treatment that stimulates areas of the brain involved in mood
Other treatments: depending on your individual situation, which Dr Charles will discuss with you.
These are possibilities to discuss with your psychiatrist. Which (if any) is appropriate depends on your assessment.
TMS as a treatment pathway
For some people with depression that has not improved with treatment, TMS may be considered as a next step.
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TMS is non-invasive and does not require anaesthesia.
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The strongest clinical evidence for TMS is in the treatment of depression.
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It is delivered as a course of 30 sessions: either three times a day over ten working days, or once a day, five days a week, over about six weeks.
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Whether TMS is appropriate for you is determined by Dr Charles in a psychiatric assessment, after a referral has been received, and is agreed with your treating doctor. Even where TMS is considered, it may not be recommended, funded, or suitable.
Exploring TMS as a treatment option
What to expect
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Outcomes vary from person to person and are not guaranteed.
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TMS is not suitable for everyone. For example, a clinical review is required if you have a history of seizures, and TMS is contraindicated where there are non-removable metallic objects near the head.
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TMS requires a commitment to attend a course of sessions.
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Medical-scheme cover is not guaranteed; funding is scheme- and patient-specific.
How to proceed
If depression has not improved adequately for you, speak to your GP, psychologist, or another doctor about a referral for a psychiatric reassessment. Dr Charles reviews the referral and, where appropriate, offers an appointment.
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Dr Charles offers face-to-face consultations in Claremont, Cape Town, and online consultations.
If you don't currently have a referral, please ask your GP or another doctor to refer you.
​If you are experiencing a psychiatric emergency, go to your nearest hospital emergency centre for assistance. This website is not an emergency service.
About Dr BN Charles
Dr BN Charles is a psychiatrist based in Cape Town, offering specialised TMS therapy at Mediclinic Crescent Mental Health Services in Claremont. His practice is dedicated to providing advanced, evidence-based neurobiological treatments that support functional recovery for patients managing treatment-resistant depression
Specialized Training
Dr. BN Charles has completed a Clinical Certification Course in Transcranial Magnetic Stimulation ( TMS ) through the Academy of Brain Stimulation, an internationally recognised organisation dedicated to advancing neuromodulation therapies
This certification ensures that TMS treatments are delivered according to international clinical standards and best practice guidelines
