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A 20-year-old male asked:

What's the next step in therapy when the antidepressants and psychotherapy doesn't work at all?

3 doctor answers9 doctors weighed in
Dr. Michael Sparacino
Family Medicine 38 years experience
Differing drugs: There are several different classes of antidepressents. If those fail, your doctor may decide to augment your therapy with another medication. Electroconvulsive therapy may be an option as well.
Dr. Jonathan Shedler
Clinical Psychology 15 years experience
If the person has been attending therapy sessions regularly and consistently and at an adequate frequency (no less than once per week, preferably twice) for a meaningful period without benefit, I'd consider a different therapist or therapy approach, not only different (potentially more dangerous) drugs or ECT.. I'd want to know what kind of therapy the person has been getting and from whom.
Oct 10, 2013
Dr. Alan Ali
Dr. Alan Alianswered
Psychiatry 33 years experience
Alternatives: Adjusting the antidepressant dose, switching to another antidepressant in same group, augmenting the antidepressant with another medicine, or using other techniques such as deep brain stimulation or ect, are all options. Discuss with your doctor.
Dr. Pamela Pappas
Psychiatry 43 years experience
Transcranial Magnetic Stimulation could be another possibility.
Sep 20, 2012
Dr. Jason Berman
A Verified Doctor commented
A US doctor answered Learn more
Also, the patient might not have a good connection with the current psychotherapist. Another therapist might make a huge difference.
Apr 30, 2013
Dr. Alan Koenigsberg
Psychiatry 43 years experience
Second opinion: Treatment resistant depression is a common problem. In major depressions, the cause is generally biologic, and biologic treatments are the mainstay of care. The person may have low thyroid, another medical illness, bipolar disorder, a gastrointestinal disorder preventing absorption, taking antacids, and so on. Transcutaneous magnetic therapy, vagal nerve stimulation, and ECT are all safe.

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