Psychiatry

Major Depressive Disorder

Major depressive disorder requires clinical confirmation after screening, assessment of suicide and bipolar risk, and individualized psychotherapy and medication selection. Use measurement-based follow-up to detect inadequate response, intolerance, or worsening risk early, and escalate care for severe, psychotic, suicidal, or treatment-resistant illness.

Clinical question: How should physicians confirm, risk-stratify, treat, and monitor adults with major depressive disorder?

Updated August 21, 20267 minute readPsychiatry

What matters in practice

A positive depression screen is not diagnostic; establish a DSM-defined depressive syndrome, assess functional impairment, and evaluate for bipolar disorder, psychosis, substance-related causes, and medical or neurologic contributors. fda+2fdaMajor Depressive Disorder: Developing Drugs for Treatment BMJDepression in adults - Symptoms, diagnosis and treatment Wolters KluwerDepression
Assess suicidality at presentation and during early treatment or dose changes; urgent psychiatric or emergency evaluation is indicated when risk cannot be safely managed in the outpatient setting. dailymed nlm nih+1dailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP BMJDepression in adults - Symptoms, diagnosis and treatment
Psychotherapy and antidepressant medication are effective first-line modalities; selection should account for severity, patient preference, prior response, comorbidity, adverse-effect priorities, access, and safety. BMJ+3BMJDepression in adults - Symptoms, diagnosis and treatment JAMAManagement of Depression in Adults: A Review acpjournalsNonpharmacologic and Pharmacologic Treatments of Adult ...acpjournalsThe Management of Major Depressive Disorder
Use structured symptom and adverse-effect measurement to guide treatment changes. In one randomized trial, measurement-based care accelerated median response from 4 to 2 weeks and remission from 8 to 4 weeks, although applicability to U.S. practice is uncertain. JAMAJAMAMeasurement-Based Care to Enhance Antidepressant Treatment Outcomes in Major Depressive Disorder: A Randomized
Before labeling depression treatment-resistant, verify diagnosis, adherence, tolerability, dose and duration adequacy, ongoing psychosocial or substance-related drivers, and bipolar-spectrum illness. fda+1fdaMajor Depressive Disorder: Developing Drugs for Treatment NEJMSingle-Dose Psilocybin for a Treatment-Resistant Episode ...

Diagnosis

Confirm the syndrome and identify conditions that change management

Screening identifies risk; clinical assessment establishes diagnosis and immediate treatment setting.

Major depressive disorder is a clinical diagnosis. Screening instruments can characterize symptom burden and support longitudinal measurement, but a positive result should trigger diagnostic interview, mental status examination, assessment of impairment, treatment planning, and follow-up rather than automatic pharmacotherapy. BMJ+1BMJDepression in adults - Symptoms, diagnosis and treatment Wolters KluwerImproving Depression Management in Primary Care : Journal of Christian Nursing

A major depressive episode requires a persistent depressed or dysphoric mood with functional interference and at least 5 depressive symptoms over at least 2 weeks; suicidal ideation or attempt is among the symptom domains. dailymed nlm nihdailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP The diagnostic interview should establish episode chronology, recurrence, psychotic symptoms, anxiety symptoms, trauma exposure, substance use, medication exposures, and medical or neurologic disease that may account for depressive symptoms. Depression may also occur with bipolar disorder, schizophrenia, neurodegenerative disorders, and Parkinson disease. Wolters KluwerWolters KluwerDepression

Before antidepressant monotherapy, obtain a focused lifetime history of mania or hypomania and family history of bipolar disorder, depression, and suicide. The mirtazapine label specifically advises bipolar-risk screening because a depressive episode can be the initial presentation of bipolar disorder and antidepressant monotherapy may precipitate mixed or manic illness in susceptible patients. dailymed nlm nihdailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP

Use a validated scale consistently once treatment begins. The PHQ-9 is widely used for depression severity and treatment-response assessment; the QIDS-SR16 and clinician-rated HDRS-17 were used in measurement-based care trials. BMJ+1BMJDepression in adults - Symptoms, diagnosis and treatment JAMAMeasurement-Based Care to Enhance Antidepressant Treatment Outcomes in Major Depressive Disorder: A Randomized
Clarify psychotic symptoms, catatonia, severe psychomotor retardation, inability to meet basic needs, and severe agitation because these findings shift urgency and may require specialty or inpatient management. BMJBMJDepression in adults - Symptoms, diagnosis and treatment
For new or disproportionate cognitive symptoms, neurologic findings, late-life onset, or atypical course, evaluate neurologic and medical differentials rather than attributing deficits solely to depression. Wolters KluwerWolters KluwerDepression

Assessment findings that alter the next clinical action. dailymed nlm nih+2dailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP BMJDepression in adults - Symptoms, diagnosis and treatment Wolters KluwerDepression
Finding	Why it matters	Immediate action
Current suicidal ideation, intent, plan, recent attempt, inability to maintain safety	Risk may escalate before remission and can change during antidepressant initiation or dose adjustment. dailymed nlm nih+1dailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP BMJDepression in adults - Symptoms, diagnosis and treatment	Perform a structured safety assessment; arrange emergency or urgent psychiatric evaluation when outpatient safety cannot be assured. BMJBMJDepression in adults - Symptoms, diagnosis and treatment
Past mania or hypomania, mixed features, bipolar family history	Antidepressant monotherapy may precipitate mixed or manic illness in susceptible patients. dailymed nlm nihdailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP	Avoid reflex antidepressant monotherapy; obtain psychiatric consultation or manage as bipolar-spectrum illness when indicated. dailymed nlm nihdailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP
Psychosis, catatonia, severe agitation, profound functional incapacity	These features indicate severe illness and potential risk to self or others. BMJBMJDepression in adults - Symptoms, diagnosis and treatment	Expedite specialty assessment and determine need for hospital-level care. BMJBMJDepression in adults - Symptoms, diagnosis and treatment
Cognitive decline, parkinsonism, focal neurologic findings, atypical late presentation	Depression can be psychiatric, neurologic, or both; neurodegenerative disease is an important differential. Wolters KluwerWolters KluwerDepression	Pursue targeted medical and neurologic evaluation. Wolters KluwerWolters KluwerDepression

Treatment

Select initial treatment by severity, urgency, and patient-specific tradeoffs

Use shared decision-making after risk stratification; do not delay urgent stabilization for a prolonged outpatient trial.

Available evidence supports specific psychotherapies and more than 20 antidepressant medications as first-line treatments for acute depression. JAMAJAMAManagement of Depression in Adults: A Review The American College of Physicians living guideline addresses both nonpharmacologic and pharmacologic treatment for adults in the acute phase of major depressive disorder. acpjournals+1acpjournalsNonpharmacologic and Pharmacologic Treatments of Adult ...acpjournalsA Clinical Practice Guideline From the American College of ... For less severe presentations, watchful waiting may be appropriate for selected patients; for more severe symptoms, active treatment is generally indicated. BMJBMJDepression in adults - Symptoms, diagnosis and treatment

Choose psychotherapy, medication, or both according to severity, prior treatment response, adverse-effect vulnerability, patient preference, treatment availability, psychiatric comorbidity, and likelihood of follow-up. BMJ+1BMJDepression in adults - Symptoms, diagnosis and treatment JAMAManagement of Depression in Adults: A Review Medication is not interchangeable with diagnostic reassessment: apparent nonresponse can reflect inadequate exposure, nonadherence, adverse effects, an incorrect diagnosis, unresolved substance use, ongoing psychosocial drivers, or bipolar-spectrum disease. fda+1fdaMajor Depressive Disorder: Developing Drugs for Treatment NEJMSingle-Dose Psilocybin for a Treatment-Resistant Episode ...

Escalate urgently for depression with psychosis, severe suicidality, severe psychomotor retardation interfering with activities of daily living, catatonia, or severe agitation. BMJBMJDepression in adults - Symptoms, diagnosis and treatment Electroconvulsive therapy is an established somatic treatment in severe depression, and a review cited its association with superior symptomatic and functional change after psychiatric hospitalization; individual indication and risk assessment require specialty management. Wolters KluwerWolters KluwerDepression

Document baseline severity and functional goals before starting treatment so that response and remission can be distinguished from subjective partial improvement. JAMA+1JAMAMeasurement-Based Care to Enhance Antidepressant Treatment Outcomes in Major Depressive Disorder: A Randomized BMJDepression in adults - Symptoms, diagnosis and treatment
Reassess adherence, adverse effects, suicidality, activation, emergent mania, and symptom trajectory early after initiating or changing an antidepressant. dailymed nlm nih+1dailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP BMJDepression in adults - Symptoms, diagnosis and treatment
In patients with inadequate response, avoid declaring treatment resistance without documenting adequate prior treatment trials. In FDA development guidance, treatment-resistant depression studies enroll patients who have not responded to more than one prior antidepressant at adequate dose and duration. fdafdaMajor Depressive Disorder: Developing Drugs for Treatment

Mirtazapine prescribing and monitoring points from FDA labeling. dailymed nlm nihdailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP
Domain	Actionable information	Clinical implication
Dose	Start 15 mg orally once daily, preferably in the evening; effective range 15-45 mg/day; do not change dose at intervals shorter than 1-2 weeks. dailymed nlm nihdailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP	Allow adequate time at each dose before judging response or tolerability. dailymed nlm nihdailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP
Suicidality	Monitor all ages for clinical worsening, suicidality, or unusual behavior, particularly during initial months and dose changes. dailymed nlm nihdailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP	Engage family or caregivers when appropriate and prescribe the smallest feasible quantity in patients at overdose risk. dailymed nlm nihdailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP
Infection symptoms	Severe neutropenia and agranulocytosis occurred rarely in premarketing trials; discontinue if infection symptoms occur with low white blood cell count. dailymed nlm nihdailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP	Evaluate fever, sore throat, stomatitis, or other infection symptoms promptly. dailymed nlm nihdailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP
Discontinuation	Abrupt cessation can cause dizziness, abnormal dreams, paresthesias, agitation, anxiety, fatigue, nausea, vomiting, and sweating. dailymed nlm nihdailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP	Taper gradually over several weeks when feasible. dailymed nlm nihdailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP
Interactions	Phenytoin and carbamazepine approximately doubled clearance; cimetidine increased exposure by more than 50%; ketoconazole increased peak level and exposure. dailymed nlm nihdailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP	Review enzyme inducers and inhibitors when efficacy or adverse effects change unexpectedly. dailymed nlm nihdailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP

Mirtazapine

Mirtazapine is FDA-indicated for major depressive disorder in adults. The labeled starting dose is 15 mg orally once daily, preferably in the evening; the usual effective range is 15 to 45 mg/day. Do not adjust more often than every 1 to 2 weeks because of its 20- to 40-hour elimination half-life. dailymed nlm nihdailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP

Its H1 antagonism is associated with prominent sedation; antagonism at 5-HT2, 5-HT3, and presynaptic alpha2-adrenergic receptors contributes to its pharmacologic profile. dailymed nlm nihdailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP It may be useful when insomnia or reduced appetite are clinically prominent, but weight gain, daytime somnolence, metabolic effects, falls risk, and cognitive impairment can outweigh benefit in some patients. This selection inference is based on labeled adverse-effect patterns rather than comparative-effectiveness evidence. dailymed nlm nihdailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP

Common short-term adverse effects included somnolence (54%), dry mouth (25%), increased appetite (17%), constipation (13%), weight gain (12%), and dizziness (7%) in U.S. controlled trials. dailymed nlm nihdailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP
Monitor weight and metabolic risk when clinically appropriate: increased appetite and at least 7% weight gain occurred more often than with placebo; nonfasting cholesterol and triglyceride elevations were also reported. dailymed nlm nihdailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP
Use caution in older adults and in moderate-to-severe renal or hepatic impairment because clearance is reduced. dailymed nlm nihdailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP
Avoid concomitant psychiatric MAOIs and maintain a 14-day washout in either direction. Do not initiate with linezolid or intravenous methylene blue because of serotonin-syndrome risk. dailymed nlm nihdailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP
Review other serotonergic agents, including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, buspirone, tryptophan, and St. John's wort; monitor for serotonin syndrome, especially during initiation and titration. dailymed nlm nihdailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP
Counsel regarding alcohol and sedative coexposures because cognitive and motor impairment is additive with alcohol and diazepam. dailymed nlm nihdailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP

Monitoring

Use measurement-based follow-up to shorten time to treatment adjustment

Structured symptom and adverse-effect data should drive decisions, not replace clinical assessment.

Measurement-based care combines repeated standardized symptom assessment with adverse-effect assessment and a predefined action plan. In a multicenter randomized trial of 154 adults with nonpsychotic MDD, the intervention used the QIDS-SR16 and FIBSER at baseline and weeks 2, 4, 8, 12, and 24 to guide dose adjustment or switching of paroxetine or mirtazapine. JAMAJAMAMeasurement-Based Care to Enhance Antidepressant Treatment Outcomes in Major Depressive Disorder: A Randomized

Compared with clinician-directed standard care, measurement-based care shortened median time to response from 4 to 2 weeks and median time to remission from 8 to 4 weeks; adjusted hazard ratios were 1.53 for response and 1.80 for remission. By week 24, response and remission rates no longer differed significantly. JAMAJAMAMeasurement-Based Care to Enhance Antidepressant Treatment Outcomes in Major Depressive Disorder: A Randomized The trial occurred in Pakistan, used only paroxetine and mirtazapine, and included protocol coordinators and more visits in the intervention arm; therefore, it supports structured follow-up but does not establish a U.S.-specific medication algorithm. JAMAJAMAMeasurement-Based Care to Enhance Antidepressant Treatment Outcomes in Major Depressive Disorder: A Randomized

A practical follow-up visit should review score trajectory, functioning, adherence, adverse effects, suicidal thinking or behavior, activation or mania, substance use, psychosocial stressors, and patient priorities. A worsening score or new safety concern requires reassessment of diagnosis, treatment setting, and safety plan rather than simple dose escalation. dailymed nlm nih+2dailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP JAMAMeasurement-Based Care to Enhance Antidepressant Treatment Outcomes in Major Depressive Disorder: A Randomized BMJDepression in adults - Symptoms, diagnosis and treatment

Define response before treatment: a 50% or greater reduction in a standardized depression score is a commonly used research definition. NEJM+1NEJMSingle-Dose Psilocybin for a Treatment-Resistant Episode ...JAMAMeasurement-Based Care to Enhance Antidepressant Treatment Outcomes in Major Depressive Disorder: A Randomized
Define remission with the instrument being used; in the cited measurement-based trial, HDRS-17 remission was a score of 7 or less. JAMAJAMAMeasurement-Based Care to Enhance Antidepressant Treatment Outcomes in Major Depressive Disorder: A Randomized
Track side-effect burden explicitly. In the trial, a FIBSER total score greater than 4 of 18 indicated poor tolerability requiring dose change or medication switch under the protocol. JAMAJAMAMeasurement-Based Care to Enhance Antidepressant Treatment Outcomes in Major Depressive Disorder: A Randomized
Continue to reassess suicide risk during treatment. Antidepressant labeling identifies early treatment and dose changes as periods requiring close observation. dailymed nlm nihdailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP

Measurement-based follow-up framework supported by trial methods and antidepressant labeling. dailymed nlm nih+1dailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP JAMAMeasurement-Based Care to Enhance Antidepressant Treatment Outcomes in Major Depressive Disorder: A Randomized
Visit component	Measure or question	Action triggered
Depressive symptoms	Use the same validated scale serially, such as PHQ-9 or QIDS-SR16. BMJ+1BMJDepression in adults - Symptoms, diagnosis and treatment JAMAMeasurement-Based Care to Enhance Antidepressant Treatment Outcomes in Major Depressive Disorder: A Randomized	Insufficient improvement should prompt assessment of treatment adequacy, adherence, diagnosis, and treatment modification. JAMAJAMAMeasurement-Based Care to Enhance Antidepressant Treatment Outcomes in Major Depressive Disorder: A Randomized
Function	Review work, caregiving, relationships, self-care, and activity goals.	Persistent functional compromise despite symptom change warrants treatment-plan revision and consideration of psychotherapy, social interventions, or specialty referral. BMJBMJDepression in adults - Symptoms, diagnosis and treatment
Adverse effects	Ask specifically about sedation, dizziness, appetite and weight change, gastrointestinal symptoms, activation, sexual effects, and treatment burden. dailymed nlm nih+1dailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP JAMAMeasurement-Based Care to Enhance Antidepressant Treatment Outcomes in Major Depressive Disorder: A Randomized	Adjust dose, timing, agent, or co-medications when tolerability threatens adherence or safety. dailymed nlm nih+1dailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP JAMAMeasurement-Based Care to Enhance Antidepressant Treatment Outcomes in Major Depressive Disorder: A Randomized
Safety	Assess suicidal ideation, intent, plan, behavior, access to lethal means, supports, and ability to maintain safety. dailymed nlm nih+1dailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP BMJDepression in adults - Symptoms, diagnosis and treatment	Escalate to urgent or emergency psychiatric evaluation when outpatient management is unsafe. BMJBMJDepression in adults - Symptoms, diagnosis and treatment

Treatment resistance

Approach inadequate response systematically before escalating

Incomplete response is common and should trigger a structured reassessment rather than therapeutic drift.

Treatment-resistant depression lacks a universally accepted clinical cut point; FDA guidance notes that response, partial response, and nonresponse lie on a continuum. For regulatory studies, treatment-resistant depression generally involves failure to respond to more than one prior antidepressant administered at an adequate dose and duration. fdafdaMajor Depressive Disorder: Developing Drugs for Treatment

Before changing therapy, verify the original diagnosis and whether the current treatment was delivered adequately. Reassess adherence, tolerability, pharmacokinetic interactions, substance use, bipolar-spectrum symptoms, psychosis, medical and neurologic contributors, and concurrent psychosocial drivers. These steps are particularly important when apparent nonresponse follows low exposure, premature discontinuation, or unrecognized activation. dailymed nlm nih+2dailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP fdaMajor Depressive Disorder: Developing Drugs for Treatment Wolters KluwerDepression

Specialty options may include medication switch, augmentation, structured psychotherapy, transcranial magnetic stimulation, electroconvulsive therapy, or other intervention depending on severity and treatment history. The supplied evidence supports the existence of these modalities but does not provide sufficient contemporary U.S. guideline detail to specify a universal sequencing algorithm. JAMA+2JAMAManagement of Depression in Adults: A Review Wolters KluwerDepression Oxford AcademicPharmacological Augmentation in Unipolar Depression

Do not use psilocybin clinically for treatment-resistant depression based on the supplied trial alone. In a phase 2 trial, a single 25-mg synthetic psilocybin dose with psychological support improved week-3 MADRS change versus a 1-mg control by 6.6 points, but sustained response at 12 weeks was not established and suicidal ideation, self-injury, and suicidal behavior occurred. NEJMNEJMSingle-Dose Psilocybin for a Treatment-Resistant Episode ...
The psilocybin trial required antidepressant tapering, preparatory and integration sessions, prolonged monitored administration, and excluded persons at clinically significant suicide risk; results should not be generalized to unsupervised or routine outpatient use. NEJMNEJMSingle-Dose Psilocybin for a Treatment-Resistant Episode ...
When considering pharmacologic augmentation, distinguish FDA-approved adjunctive strategies from off-label approaches and discuss uncertainty, adverse effects, and monitoring burden. A meta-analysis found brexpiprazole adjunctive therapy improved symptom, response, and remission outcomes versus placebo but increased adverse-event discontinuation, akathisia, and weight gain. Wolters KluwerWolters KluwerAdjunctive Brexpiprazole as a Novel Effective... : Journal of Clinical Psychopharmacology

High-value reassessment domains in apparent antidepressant nonresponse. dailymed nlm nih+3dailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP fdaMajor Depressive Disorder: Developing Drugs for Treatment NEJMSingle-Dose Psilocybin for a Treatment-Resistant Episode ...Wolters KluwerDepression
Domain	Questions to answer	Consequence
Diagnostic validity	Is this unipolar MDD, bipolar depression, psychotic depression, substance-related depression, or depression secondary to medical or neurologic disease? dailymed nlm nih+1dailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP Wolters KluwerDepression	A changed diagnosis changes medication choice, urgency, and specialty referral. dailymed nlm nih+1dailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP Wolters KluwerDepression
Treatment adequacy	Was the drug taken consistently at a therapeutic dose for sufficient duration, with manageable adverse effects? dailymed nlm nih+1dailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP fdaMajor Depressive Disorder: Developing Drugs for Treatment	Correct inadequate exposure before declaring resistance. dailymed nlm nih+1dailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP fdaMajor Depressive Disorder: Developing Drugs for Treatment
Safety and acuity	Has suicidality, psychosis, catatonia, agitation, or inability to function emerged? BMJBMJDepression in adults - Symptoms, diagnosis and treatment	Move to urgent specialty or inpatient evaluation when indicated. BMJBMJDepression in adults - Symptoms, diagnosis and treatment
Advanced intervention	Is there persistent disabling illness despite adequate trials, or need for rapid definitive symptom control? Wolters KluwerWolters KluwerDepression	Refer for specialty evaluation of somatic and augmentation options. Wolters Kluwer+1Wolters KluwerDepression Oxford AcademicPharmacological Augmentation in Unipolar Depression

Common questions

Is a positive PHQ-9 sufficient to diagnose major depressive disorder?

No. The PHQ-9 is useful for screening and serial severity measurement, but diagnosis requires clinical assessment of depressive syndrome, impairment, differential diagnosis, bipolar risk, and safety. BMJ+1BMJDepression in adults - Symptoms, diagnosis and treatment dailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP

When should an antidepressant be changed for nonresponse?

Do not rely on a single calendar threshold alone. Confirm adherence, dose and duration adequacy, adverse effects, interactions, diagnosis, bipolar-spectrum symptoms, substance use, and safety; then modify treatment using serial symptom measurement. dailymed nlm nih+2dailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP fdaMajor Depressive Disorder: Developing Drugs for Treatment JAMAMeasurement-Based Care to Enhance Antidepressant Treatment Outcomes in Major Depressive Disorder: A Randomized

What monitoring is required after starting mirtazapine?

Monitor early for worsening depression, suicidality, unusual behavioral change, activation or mania, sedation, dizziness, appetite or weight gain, metabolic effects, and infection symptoms suggestive of neutropenia. Review serotonergic drugs, MAOIs, alcohol, sedatives, and enzyme modifiers. dailymed nlm nihdailymed nlm nih479 Mirtazapine 15 mg Mirtazapine Tablets, USP

Does psilocybin have an established role in treatment-resistant depression?

Not from the supplied evidence. A phase 2 trial found a week-3 benefit for a monitored 25-mg synthetic psilocybin session with psychological support, but durability was uncertain and serious suicidal events occurred; larger comparative studies were deemed necessary. NEJMNEJMSingle-Dose Psilocybin for a Treatment-Resistant Episode ...