Using selective serotonin reuptake inhibitors (SSRIs) only

Commonly, I see patients who have been trialed on multiple SSRIs without any additional consideration of other antidepressants such as serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), or monoamine oxidase inhibitors (MAOis); the latter usually have more efficacy for treatment-resistant depression.

Focusing only on treating recurrent major depression and not considering alternative conditions (PTSD, bipolar depression, borderline personality disorder, chronic dysthymia)

If an individual has been trialed on many antidepressants without a significant improvement in mood symptoms, considering alternative diagnoses can be helpful in adjusting medication management strategies to improve treatment outcomes.

Using antipsychotic augmentation too quickly in medication trials

Some patients have only been trialed on one antidepressant before adding augmentation with an antipsychotic; in these cases, the patient may have a higher likelihood of increased efficacy with trialing an alternative antidepressant.

Caveat: Antipsychotic augmentation of depression treatment is an effective strategy for some individuals, but one that should be considered carefully before starting.

Focusing on medication management only and not considering therapeutic and alternative interventions

Medications are not the only form of treatment for depression. Effective psychotherapy can have equivalent effects in treating depressive symptoms. Additionally, the use of alternative treatments such as bright light therapy, L-methylfolate, SAMe, and Omega-3 supplements can also have some benefit in treating depressive symptoms.