Interview With Dr. Geoffrey Grammer: New Frontiers In Treating Depression When Meds Fail A Little Help For Our Friends podcast

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Interview with Dr. Geoffrey Grammer: New Frontiers in Treating Depression When Meds Fail

2d ago 52:01

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What if you've tried everything, but are still depressed? Did you know that one third of people with depression don’t get enough relief from antidepressants? In this episode, I talk to psychiatrist and CMO of Neuronetics, Dr. Geoffrey Grammer, about what should people do when our mainstream treatments for depression fails us. He sheds light on new advancements for treatment-resistant depression: transcranial magnetic stimulation (TMS) and nasal esketamine, two evidence-based treatments that target the brain differently and raise the odds after meds stall.
We first talk about just how disappointing traditional medications and psychotherapies can be for chronically depressed patients. Then, Dr. Grammer explains how TMS works (precise, noninvasive brain stimulation that strengthens underactive mood circuits), what a session feels like, timelines for improvement, and why side effects are minimal compared to systemic drugs. We also explore nasal esketamine (Spravato) and how it works. Along the way, we dig into augmentation meds, common pitfalls, and the role of psychotherapy in turning short-term gains into lasting change.
Real patient stories ground the science in hope: remission after years of struggle, renewed presence with family, and the hard-won confidence that life can feel different. If you’ve tried two antidepressants without clear progress or hate the side effects, your next step shouldn’t be “another pill” - it should be to advocate for yourself with your providers and explore these new options.
Resources:

NeuroStar website: https://neurostar.com/
NeuroStar's assessment quiz for depression: https://neurostar.com/self-assessment-for-depression/
Find a doctor page: https://neurostar.com/enter-zip-code/?as=0
Connect to Dr. Grammer on social:

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Chapters

1. Welcome And Coaching Resource (00:00:00)

2. Meet Dr. Jeffrey Grammer (00:00:49)

3. Why Antidepressants Fail One Third (00:00:50)

4. STARD Trial And Heterogeneous Depression (00:02:22)

5. Defining Treatment Resistance And Its Toll (00:03:54)

6. Where ECT And Psychotherapy Fit (00:05:16)

7. Therapy As Recovery Skill Building (00:07:37)

8. When To Stop Adding Meds (00:09:19)

9. How Augmentation Drugs Work And Risks (00:11:10)

10. Side Effects, Individual Differences, And Advocacy (00:14:43)

11. What Is TMS And How It Works (00:17:04)

12. Personalizing Targeting And Evidence (00:19:10)

13. What A TMS Session Feels Like (00:20:52)

14. Efficacy, Awareness, And Access (00:22:39)

15. Finding Providers And Insurance Basics (00:24:02)

16. Beyond Depression: OCD And Caution On Claims (00:26:32)

17. Why NeuroStar’s Design Differs (00:28:21)

18. Modern Care Moves Faster Than Culture (00:31:19)

19. Nasal Esketamine: Process, Safety, Maintenance (00:32:09)

20. IV Ketamine Versus Spravato And Cost (00:34:19)

21. Who Should Not Use TMS Or Esketamine (00:36:04)

22. Patient Stories And Lasting Remission (00:37:41)

23. Where To Get Care And Closing (00:40:13)

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