What should be done if a single SSRI is not successful in treating depression?

When a single selective serotonin reuptake inhibitor (SSRI) is not successful in treating depression, considering a combination of antidepressants or adding lithium can be an effective next step. This approach is based on the understanding that some patients may not respond adequately to monotherapy with an SSRI alone.

Combining different classes of antidepressants or augmenting with a medication like lithium can help address various neurotransmitter systems, potentially leading to better symptom relief. For instance, adding lithium can enhance the effectiveness of serotonin-focused medications, particularly for those with treatment-resistant depression.

Moreover, combination therapy may be particularly beneficial for individuals who have not responded to one medication but may respond to the synergistic effects of multiple agents. This strategy allows for a more nuanced treatment plan that can cater to an individual's specific clinical needs and may improve overall outcomes.

In contrast, just switching to a different SSRI without exploring combination therapy may not address the underlying issues for non-response. Simply increasing the dose of the initial SSRI may also not yield the desired improvement, as there is a pharmacological ceiling effect beyond which higher doses do not provide additional benefit and can lead to increased side effects. Referring immediately for psychotherapy can be a valuable part of a comprehensive treatment plan, but it