When do you choose to switch to antidepressants vs augmentation in treatment-resistant depression?

When I approach depression that has been resistant to many antidepressant trials, I consider the following:

First, I reassess the diagnosis. This includes considering comorbidities such as menopause symptoms, ED symptoms, exacerbation of chronic medical issues, and onset of MNCD. I ensure I have con...

Treatment-resistant depression has been profoundly rare in my private practice over the past 34 years. Most patients with the diagnosis of treatment-resistant depression that I see aren't really depressed. They have a pessimistic explanatory style which doesn't respond to any medications. If they do...

If the first antidepressant at full therapeutic doses, and after sufficient time to maximize its efficacy, has shown partial benefit, I would most likely not taper and stop it, but rather use a second-generation antipsychotic medication.

If, however, I thought there could be some elements of bipolar...

Treatment-resistant depression is an interesting condition. I would first do a thorough interview, get extensive collateral, and try to do a good differential before thinking about treatment options. Is this TRD or undiagnosed bipolar depression or bipolar 1 or 2 starting as depression before having...