A 79 year-old male is brought by his family for evaluation of severe treatment-refractory depression. His current episode has lasted 6 months and has not responded to to full courses of venlafaxine and citalopram. His current regimen is fluoxetine 80 mg/d, olanzapine 15 mg/d, and risperidone 3 mg/d, without benefit. He is a practicing attorney and has been unable to function. He also has hypertension and coronary artery disease, both treated and controlled with medications. He has had 5 episodes in the past.
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