In patients with disorders of gut-brain interaction that fail trial of neuromodulator, is there any utility in trying a different neuromodulator or adding an additional one?

In patients with disorders of gut-brain interaction that fail trial of neuromodulator which of the following do you try next?

• Switch to another neuromodulator in the same class (i.e. tricyclic antidepressants, SNRI, SSRI, tetracyclic antidepressants )
• Switch to another class of neuromodulator (i.e. tri-cyclic antidepressants, SNRI, SSRI, tetracyclic antidepressants )
• Trial combination therapy
• Other