Use In Parkinson disease with depression, which antidepressant is favored, a newer pharmacotherapy for treatment-resistant depression, and pharmacogenomic tests reliable for predicting antidepressant response or sensitivity to frame the working diagnosis and next step; treat it as a safety constraint before prescribing or reassuring. Make a newer pharmacotherapy for treatment-resistant depression the checkpoint that determines whether you escalate testing, narrow the differential, or change treatment.

It should definitely be offered in cases involving a high risk of suicide, late-life depression, catatonia, or severe psychotic depression; Standard first-line approach combines cognitive behavioral therapy, specifically exposure and response prevention, with S-S-R-Is, which often require higher doses and longer trial periods to be effective; Bupropion is often preferred as a first-line option because its dopaminergic effects can be particularly beneficial in this population; Ketamine has emerged as a newer option, and it's available in both intranasal and intravenous formulations; Options include repetitive transcranial magnetic stimulation—or r-T-M-S—vagus nerve stimulation, over-the-counter and professional transcranial direct current stimulation devices, and bright light therapy