Why So Many Depression Patients Don’t Get Better - And What Actually Helps with Dr Scott West

Send us Fan MailWhen depression does not lift with medication, people often assume the next step is simply “try another tablet” and wait. That waiting can cost years of energy, work, relationships, and self-belief. I sit down with Dr Scott West, Chief Medical Officer at Nashville Neurocare Therapy and a board-certified psychiatrist with over 30 years of experience, to talk plainly about what options look like when standard care stalls and what modern neurocare is doing differently.We dig into transcranial magnetic stimulation (TMS therapy) as an outpatient neuromodulation treatment, how it moved from early research to real-world clinical use, and why it has become a meaningful tool for treatment-resistant depression. We also explore how TMS has expanded into anxious depression and OCD, why diagnosis labels can lag behind what brain-circuit treatments are actually doing, and how combining approaches like psychotherapy and medication management can improve response and remission. Along the way, we tackle a topic patients feel immediately: expectations. Even with symptom improvement, stress at home, work conflict, and unmet coping skills can pull people back into relapse if those pieces stay untouched.Then we go behind the scenes of mental health care delivery: hiring and training great staff, tracking outcomes, managing bottlenecks, and navigating insurance coverage for TMS and treatments like esketamine. We also talk about the awareness gap, why many clinicians still do not refer, and how digital monitoring tools could help clinics understand longer-term results after patients return to the community. If you care about practical mental health innovation, this is a grounded look at where neurocare is now and where it is heading next. Subscribe for more conversations like this, share the episode with someone who needs better options, and leave a review telling us what topic you want us to unpack next.Guest BiographyDr. Scott West is a board-certified psychiatrist with over 30 years of clinical experience, specializing in the treatment of depression and treatment-resistant mental health conditions. He is the Chief Medical Officer at Nashville NeuroCare Therapy, where he focuses on integrating advanced neurotherapies such as transcranial magnetic stimulation (TMS) into patient care. Dr. West’s work bridges traditional psychiatry and emerging neuromodulation approaches, with a focus on improving patient outcomes and expanding access to innovative mental health treatments.LinksWebsite: https://nashvilleneurocare.com/LinkedIn: https://www.linkedin.com/in/scott-west-90190323/Subscribe on SubstackVoices in Health and Wellness is published on Substack, as part of The Diagnostician. Every episode lands there with written notes and reflections you won't find in the podcast feed. Free to subscribe.👉 https://thediagnostician.substack.com/s/voices-in-health-and-wellnessAbout the podcastVoices in Health and Wellness features conversations at the intersection of medicine, lifestyle, and human potential, with clinicians, scientists, and thinkers shaping the future of care.About Dr Andrew GreenlandUK-based medical doctor and founder of Greenland Medical, specialising in Integrative and Functional Medicine. Trained in both conventional and root-cause approaches, Andrew helps people optimise health, performance, and longevity, with a focus on cognitive resilience and healthy ageing.