A lot of people assume the treatments beyond antidepressants are only available at a big-city academic center hours away. In the St. Louis region, that's usually not the case. The two main FDA-authorized next steps are the kind of care that specialized local clinics provide. And they're worth asking about sooner than most people do - you don't have to wait until you've tried everything first.
What "next step" care looks like locally
If you live in St. Charles, O'Fallon, Wentzville, St. Peters, Lake Saint Louis, Chesterfield, Wildwood, or Ballwin, or anywhere across St. Charles County, St. Louis County, or the greater St. Louis area and have tried more than one antidepressant without relief, the options don't change because of your zip code. The same two FDA-authorized treatments apply:
- TMS, a drug-free, in-clinic treatment that uses magnetic pulses, done while you're awake.
- Esketamine (Spravato), an FDA-approved nasal spray given in a certified clinic with about two hours of monitoring.
Both are for treatment-resistant depression, and both are offered by clinics that specialize in exactly this.
Insurance and MO HealthNet
One of the biggest quiet barriers is the assumption that these treatments are out of financial reach. In Missouri, TMS and esketamine are covered by many insurance plans when medical criteria are met, and that includes many people on MO HealthNet, the state Medicaid program. Coverage always depends on your specific plan, so the honest move is to have the clinic and your insurer confirm the details for your situation.
How to actually get started
You have two honest paths, and they work together:
- Ask a specialized local clinic to screen you for candidacy. A good one will tell you plainly whether these treatments fit, before any commitment.
- Bring the same options to your own doctor and ask for a referral. Your own physician's recommendation is, for most people, the single biggest thing that turns "someday" into an appointment. We wrote a short script for that conversation.
Brain Recovery Centers, serving St. Charles County and St. Louis County
Brain Recovery Centers is a doctor-supervised clinic serving St. Charles County and St. Louis County across the greater St. Louis area, focused specifically on treatment-resistant depression and PTSD, offering FDA-approved esketamine and FDA-cleared TMS, covered by most insurance including MO HealthNet. Their short screener will tell you honestly whether you're a candidate, or what to bring to your own doctor if you're not.
Areas servedSt. Charles County and St. Louis County - St. Peters, O'Fallon, Wentzville, Lake Saint Louis, Cottleville, Dardenne Prairie, Chesterfield, Wildwood, Town and Country and Ballwin - in person and by telemedicine.
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