Second Opinion · Private Psychiatry UK

When treatment isn't
working — a different view

Treatment-resistant depression is not a life sentence. It is often a signal that the current approach needs rethinking — not that nothing will ever help.

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GMC Registered Consultant Psychiatrists

FRCPsych Royal College Fellows

CQC Regulated Registered Clinic

If any of this sounds familiar

Many people arrive here after years of trying
what they were told would help

"I've tried three or four different antidepressants and none of them have really worked — or they stopped working after a while."

"My psychiatrist keeps adjusting the dose or adding another medication, but something still feels wrong at the root."

"I've been told I have treatment-resistant depression but nobody has really explained what that means or why."

"I feel like something important about my situation isn't being seen — and I want a fresh pair of clinical eyes on my case."

1 in 3 people with depression do not respond adequately to their first antidepressant treatment NICE NG222

50% of those diagnosed with treatment-resistant depression may have an underlying condition that was not identified at first presentation Clinical literature

75–90
min initial assessment — the time we believe is necessary to truly understand a complex psychiatric history Our standard

Understanding the diagnosis

What "treatment-resistant depression" actually means

Treatment-resistant depression (TRD) is typically defined as depression that has not responded to at least two antidepressants tried at adequate doses for adequate duration. It is a clinical description — not a verdict on the person, and not a permanent condition.

What the label does not tell you is why the treatment has not worked. And that question — the why — is where a careful second opinion can make a genuine difference.

Common reasons treatment has not worked include:

The underlying diagnosis is not straightforward depression — features of bipolar disorder, ADHD, PTSD or a personality pattern may have been missed
Physical factors have not been adequately investigated — thyroid function, vitamin D, B12, sleep apnoea and inflammatory markers can all mimic or perpetuate depression
Psychosocial factors — relationship, environment, life context — remain unchanged and are maintaining the low mood regardless of medication
The medication chosen was not well-matched to the individual's presentation or pharmacological profile
The dose has been adequate but the duration has not, or vice versa

A second opinion does not begin with the assumption that more medication is the answer. It begins by asking whether the right questions have been asked.

Ready to talk?

A different clinical perspective
can change everything

Our second opinion consultations take time — because your history deserves time. No rushed appointments, no automatic prescription.

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What happens

What our second opinion process involves

Initial consultation — 75 to 90 minutes

A thorough review of your full psychiatric history, previous diagnoses, all medications tried, physical health factors and life context. This is not a standard 20-minute appointment. We need time to understand the whole picture before forming any view.

Independent clinical formulation

We provide our independent clinical view of your presentation — including our assessment of the diagnosis, any factors we believe may have been missed, and our honest opinion of what has and has not been tried. This is not a rubber stamp on existing treatment.

Written report and recommendations

A detailed written summary of our findings and recommendations — including any further investigations we suggest, treatment options we believe are worth exploring, and, where appropriate, our view on whether the current medication approach is optimal.

Ongoing care if you want it

A second opinion is complete in itself — you are under no obligation to continue with us. If you would like ongoing support, including any treatment changes recommended, we are available for that. The choice is entirely yours.

Common questions

Questions people often ask

No. You can self-refer directly. It is helpful — but not required — to bring any previous psychiatric letters, clinic notes or GP summaries to the consultation. If you have them, they allow us to make better use of the time.

Only with your explicit consent. We will always ask before sharing anything with other clinicians. If you do give consent, we will send a copy of our report to your GP and/or treating psychiatrist — which we find is usually welcomed and often opens up a more productive conversation about your care.

We will tell you honestly. A second opinion that simply confirms the existing view is not always unhelpful — sometimes reassurance is valuable. But if we see things differently, we will explain why, what we believe has been missed, and what we would recommend. We do not soften clinical findings to avoid discomfort.

Yes — receiving a private second opinion does not affect your NHS care. Many people find it useful to bring the report from a private second opinion to their NHS appointments to support a conversation about treatment options. We can advise on how to do this effectively.

Both. We offer consultations in London and online via secure video across the UK. The quality of the assessment is the same in both formats — for a second opinion, online is a perfectly appropriate option for most people.

When treatment isn'tworking — a different view

Many people arrive here after years of tryingwhat they were told would help