How do you view the risk of tardive dysinesia and other side effects in your female patients with treatment-resistant depression who are stable on an atypical antipsychotic?

Superb question, and it also applies to bipolar disorder, which is even more challenging in this patient population. I like Dr. @Dr. First Last's answer, always a risk/benefit analysis. Probably what you are already doing is my guess, since you are asking this question. Make sure you are doing consi...

Document that the risks (side effects) and benefits (quality of life) were discussed with the patient, have the patient sign the document that says the patient wishes to take the risks, and then treat the patient with the meds that successfully reduce the symptoms.

• Discuss all effects at the start of the medication.
• Keep documenting AIMS every month or less frequently at every visit.
• Reduce the dose as soon as you can and keeping alternate meds in mind, and replace as soon as you can.

There is always a risk/benefit balance. Fortunately, the risk with newer agents is way lower than with first-generation ones. Stick to the lowest dose that works and watch for abnormal movements.

I have found Abilify to be very good as adjunctive therapy at fairly low doses to quickly reduce depressive symptoms. Unfortunately, of all the SGAs, I have found it most likely to cause TD, especially in this older female population.