Treatment-resistant depression (TRD) is an expensive problem for employers, driving more than one third of employers' total medical spending for the disease. TRD is defined as major depression that fails to respond to at least two different antidepressants. Clinical studies indicate that 30-50% of adults with depression fall into this category, resulting in disability leaves, increased healthcare utilization and productivity losses that significantly impact employer costs. Breakthroughs in mental health therapies such as IV ketamine for TRD are reshaping the landscape of employee benefits. Expanded access could bring life-changing treatment to many.