ECT
First-line for severe psychotic depression. In other cases of TRD, may prefer over TMS if severe. Also works for bipolar depression.
Psychotic Depression
Nortriptyline
[Pamelor] First-line tricyclic, low sedation/anticholinergic/hypotension risk. More
noradrenergic.
Aripiprazole
[Abilify] Among the better-tolerated antipsychotics, and best-studied for antidepressant
augmentation [1] (but doesn't treat bp-depression). Schizophrenia [1]
Olanzapine
[Zyprexa] High efficacy in schizophrenia [2], so use before moving to clozapine. Mania [2], augmentation in unipolar [3], PTSD [3].
Lithium
Best long-term outcomes in bipolar (I or II) and recurrent depression. Prevents suicide. Treats mania, bp-depression and augments antidepressants.