What happens when therapy and medication don’t work? Treatment-resistant depression can feel like a dead end — but it’s not. In this episode, clinical psychologist and ADAA member expert Dr. Jill Emanuele unpacks the nuanced differences between sadness, grief, and major depressive disorder — and why misusing these terms can delay real help.But the conversation doesn’t stop there. What happens when traditional treatments for depression don’t work? You’ve probably heard the term treatment-resistant depression, and it may sound terrifying. Dr. Emanuele and host Gabe Howard dig deep into what this label actually means — and spoiler alert: It’s more about strategy than severity. You’ll also discover lesser known but evidence-backed options that go beyond talk therapy and antidepressants, including: transcranial magnetic stimulation (TMS) ketamine and esketamine treatments radically open dialectical behavior therapy (RO-DBT) electroconvulsive therapy (ECT) without the Hollywood horror spin psychedelic-assisted therapy using psilocybin  Key takeaways: the difference between sadness, grief, and clinical depression what treatment resistant actually means a breakdown of advanced, research-backed treatment options why individualization is key to recovery This episode is your roadmap for understanding treatment-resistant depression on a deeper level — and for finding hope when treatment doesn’t seem to be working. Whether you’re managing this yourself or supporting someone who is, you’ll walk away knowing there are more options — and find that labels aren’t life sentences. Special thanks to Johnson & Johnson for providing funding for today's episode. Our guest, Jill M. Emanuele, PhD, is Founder and Executive Director of Urban Yin Psychology, PLLC, based in New York City.  She is also Secretary and board member for the Anxiety and Depression Association of America (ADAA).  Dr. Emanuele completed her undergraduate studies with degrees in Psychology and Music from the University of Richmond, and her Ph.D. in clinical psychology from George Mason University. Dr. Emanuele has presented at academic medical centers, professional conferences, public and private schools, and community organizations on the topics of mindfulness, adolescent depression and suicide, adolescent self-injury, DBT, and adolescent borderline personality disorder, and co-authored book chapters on some of these important topics.  She also provides education through multiple forms of media including television, radio, internet, and podcasts.  Our host, Gabe Howard, is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, "Mental Illness is an Asshole and other Observations," available from Amazon; signed copies are also available directly from the author. Gabe is also the host of the "Inside Bipolar" podcast with Dr. Nicole Washington. Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can’t imagine life without. To book Gabe for your next event or learn more about him, please visit gabehoward.com. Learn more about your ad choices. Visit megaphone.fm/adchoices