Advanced Medication Strategies for Treatment-Resistant Depression

When standard antidepressants haven’t worked, evidence-based augmentation options can help.

Many patients are told to “just try another antidepressant.”

At Redbud, we go further — using evidence-based strategies

that are often overlooked in modern psychiatry.

Options We May Consider:

  • Lithium augmentation — a highly effective antidepressant with neuroprotective properties

  • MAOIs (monoamine oxidase inhibitors) — working on serotonin, norepinepherine, and dopamine simultaneously. Highly effective for some patients.

  • Thyroid hormone (T3) — boosts response in combination with antidepressants

  • Dopamine agonists (e.g., pramipexole) — benefits in depression with associated inflammation, loss of enjoyment, fatigue and low motivation

  • FDA-approved antipsychotic add-ons — targeted option when mixed features are present

Your plan is individualized — based on your treatment history, medical conditions, and personal goals. We focus on maximizing benefit while minimizing side effects.

Use medication for what it’s good for, not for what it’s not. Understand the problem we’re trying to solve. Use what works, not what’s new.

  • I find axioms from Dr. Nassir Ghaemi helpful in thinking about prescribing: “Your treatment is as good as your diagnosis,” “Treat diseases, not symptoms,” and “All drugs are guilty until proven innocent.”

    I use a hierachical diagnostic framework, focusing on mood disorder treatment (when relevant). I carefully review past treatment history to insure that I provide you with options that are rational and not duplicative of prior ineffective treatments.

  • We will take time to clarify your goals, explore whether your symptoms are more consistent with a disease or a reaction/problem in living, the risks, benefits, and alternatives to a particular medication plan, and then monitor the efficacy of our plan over time.

  • By getting clear about how medications are most likely to help we can decide if they make sense for you and create a plan that aligns with your goals and your unique situation.

Explore Options Beyond Standard Medications

Questions?

FAQs

  • Yes, I can work with people to discontinue some medications, such as antidepressants, when they are no longer necessary, but are causing withdrawal symptoms if stopped abruptly or rapidly tapered.

  • Skeptical and distant. I do not take any type of gratuities (meals, etc.) from drug companies. I do not participate in continuing education or ‘detailing’ directly from drug companies. I actively monitor the conflicts of interests of presenters at trainings I attend and prioritize those that do not have drug company support.