In a frail older adult with depression unresponsive to two SSRI trials, what's your next step in management?

This is certainly a longer and nuanced conversation.

Depends on the intensity of symptoms. Ensuring the diagnosis is accurate, reviewing the role of co-morbid cognitive disorders, organic issues masquerading as depression, and so on. Augmentation of an SSRI, e.g., mirtazapine, stimulating medication...