Laura, a 38-year-old female with severe MDD, has been on esc…

Laura, a 38-year-old female with severe MDD, has been on escitalopram for 12 weeks with minimal improvement. Genetic testing shows she has a polymorphism in the BDNF (brain-derived neurotrophic factor) gene, which is linked to poor neuroplasticity and antidepressant response. What treatment approach is most appropriate for Laura?

John, a 38-year-old male with MDD and GAD, has been on sertr…

John, a 38-year-old male with MDD and GAD, has been on sertraline 100 mg daily for 8 weeks. His depressive symptoms have moderately improved, but he reports persistent restlessness, excessive worry, and difficulty sleeping. He also complains of new-onset sexual dysfunction, which is straining his relationship. What is the best pharmacological adjustment?

Sophia is a 54-year-old female with treatment-resistant depr…

Sophia is a 54-year-old female with treatment-resistant depression (TRD). She has tried multiple medications, including sertraline, venlafaxine, and bupropion, at adequate doses and durations without significant improvement. She also has a history of mild renal insufficiency and hypertension, both controlled on medication. She reports fatigue, anhedonia, and difficulty concentrating. Which advanced treatment option would be most appropriate to consider?