treament failures

[gabafan]

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So you have a patient who has been a non-responder when given SSRI's, SNRI's, bupropon, and maybe a mood stabalizer. Would you look to ECT, or if you have a wealthy patient, TMS? Or would you consider TCA's or MAOI's? Let's say the patient is not suicidal, with no history of attempts. Let's also assume compliance, and that the dosing of the above were optimized. Also, would your choice differ if the patient has atypical vs. melencholic symptoms?

 

[michaelrack]

So you have a patient who has been a non-responder when given SSRI's, SNRI's, bupropon, and maybe a mood stabalizer. Would you look to ECT, or if you have a wealthy patient, TMS? Or would you consider TCA's or MAOI's? Let's say the patient is not suicidal, with no history of attempts. Let's also assume compliance, and that the dosing of the above were optimized. Also, would your choice differ if the patient has atypical vs. melencholic symptoms?

tca, especially if melancholic

 

[SuperSoccer19]

So you have a patient who has been a non-responder when given SSRI's, SNRI's, bupropon, and maybe a mood stabalizer. Would you look to ECT, or if you have a wealthy patient, TMS? Or would you consider TCA's or MAOI's? Let's say the patient is not suicidal, with no history of attempts. Let's also assume compliance, and that the dosing of the above were optimized. Also, would your choice differ if the patient has atypical vs. melencholic symptoms?

Not impressed with the evidence to support TMS, but I would probably consider ECT even before this point if the patient was open to it. We tend to look at it as a last resort when really its a very effective treatment with more stigma then risks.