Table of Contents
Part I: The Flawed Blueprint – Why the “Best Antidepressant” Is a Myth
The Agony of the “Whack-a-Mole” Approach
For years, both as a researcher and in my clinical practice, I’ve witnessed the profound frustration that accompanies the search for an effective antidepressant.
I recall one case in particular that crystallized the problem for me.
A young woman, bright and full of potential, was trapped in the grip of a severe depression.
We began what has become a tragically standard process: a first-line selective serotonin reuptake inhibitor (SSRI).
Weeks turned into a month of nausea and emotional numbness, with no relief from her underlying despair.
We switched medications.
The cycle repeated.
With each new prescription, hope flickered and then faded, leaving behind a residue of side effects and deepening hopelessness.
She described the experience as “whack-a-mole with my brain chemistry,” a journey that made her feel, in her own words, “unfixable”.1
When we eventually tapered her off one medication, she experienced the jarring, electric-shock sensations known as “brain zaps,” a common and distressing withdrawal symptom that only amplified her fear and sense of being broken.1
This story is not an outlier; it is the norm.
The “trial-and-error” approach to prescribing antidepressants is not a matter of individual bad luck but a systemic issue rooted in a flawed biomedical paradigm.3
The landmark Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, the largest of its kind, revealed a sobering reality: even with optimized care, only about 30% of patients with major depressive disorder achieve remission with their first antidepressant trial.3
This means the majority of individuals are subjected to a long, frustrating journey that can prolong suffering, increase healthcare costs, and, most insidiously, reinforce the negative thoughts and hopelessness that are hallmarks of the illness itself.3
The very question, “What is the best antidepressant?” is therefore fundamentally flawed.
It presumes a uniformity that simply does not exist.
Research makes it clear that depression is a polymorphic and heterogeneous disorder, meaning it manifests differently in different people for different reasons.5
The era of the “one-size-fits-all” or “prêt-à-porter” drug is obsolete; we must move toward a model that is tailored and custom-made.6
This process of repeated failure carries a hidden, compounding cost.
Each unsuccessful trial is not a neutral event.
It begins with a leap of faith, followed by weeks of enduring side effects with the hope of eventual relief.4
When that relief doesn’t come, the patient is left with the physical discomfort of withdrawal and the psychological weight of another failure.
This cycle erodes hope, strains the crucial doctor-patient relationship, and wastes precious time and resources.
More profoundly, this protracted process can condition a patient
not to respond to subsequent treatments, creating a self-fulfilling prophecy of resistance.3
The damage is done not just by the illness, but by the very search for a cure.
The Epiphany: From Seed-Planter to Landscape Architect
My own perspective shifted dramatically not in a lab, but while observing the principles of a completely different field: landscape architecture.
I realized that a master gardener would never ask for the single “best seed” to plant in any random plot of land.
Success isn’t about finding a miracle seed; it’s about becoming a systems thinker.
A landscape architect begins by deeply analyzing the entire ecosystem: the composition of the soil, the amount of sunlight and rainfall, the regional climate, and the other plants that will share the space.
Only after this comprehensive assessment do they select the plants that are genetically suited to thrive in that unique environment.
This analogy became the key to a new paradigm.
To effectively treat depression, we must stop acting like frantic seed-planters, tossing medications at a problem and hoping one takes root.
We must become Landscape Architects of the Mind.
This requires a fundamental shift from the traditional “top-to-bottom” approach, where a diagnosis dictates a standard treatment, to a “bottom-up” approach, where we start with the individual and build a personalized strategy from the ground up.5
This change in metaphor does more than just reframe the problem; it fundamentally shifts the locus of control and agency in treatment.
The old “seed-planter” model is passive and external.
The patient waits for an outside agent—the pill—to fix them.
When the pill fails, the patient feels broken and “unfixable”.1
The “landscape architect” model, however, is active, collaborative, and empowering.
It reframes the patient and clinician as partners in a creative, investigative process.
It acknowledges that many elements of the mental “ecosystem”—lifestyle, environment, thought patterns—are within the patient’s control, giving them a vital and active role in their own recovery.9
This aligns perfectly with the “mutual participation model” of the doctor-patient relationship, in which the patient is an expert in their own life and their involvement is essential for designing treatment.11
The journey changes from one of passive waiting to one of active, hopeful cultivation.
Part II: The Landscape Architect’s Framework – A Four-Pillar Approach to Personalized Treatment
Pillar 1: Soil Analysis – Understanding Your Unique Biology
Just as a gardener must first analyze the soil, the first step in personalized depression treatment is a deep analysis of the individual’s unique biology.
This goes far beyond a simple checklist of symptoms.
It involves understanding the genetic, metabolic, and systemic factors that constitute the “soil” in which the depression has taken root.
The Genetic Blueprint (Pharmacogenomics)
The most direct form of “soil analysis” available today is pharmacogenomic (PGx) testing.
This field examines how your specific genetic variations influence your response to medications, moving treatment from a guess to a genetically informed decision.13
PGx testing analyzes key genes, most notably
CYP2D6 and CYP2C19, which code for liver enzymes responsible for metabolizing a majority of commonly prescribed antidepressants.8
Based on your genetic makeup, you can be classified into one of several metabolizer categories:
- Poor Metabolizers: Break down drugs very slowly. A standard dose might build up to toxic levels, causing severe side effects.
- Intermediate Metabolizers: Process drugs more slowly than normal. They may require a lower dose.
- Normal Metabolizers: Have the expected enzyme function and are likely to respond to standard dosing.
- Ultrarapid Metabolizers: Break down drugs very quickly. A standard dose may be eliminated from their system before it can exert a therapeutic effect, rendering it useless.
Understanding a patient’s metabolizer status can prevent months of frustration.
Real-world studies have shown that using PGx testing to guide prescriptions can significantly reduce the use of ineffective medications and, remarkably, lead to lower rates of psychiatric hospitalizations and emergency room visits.16
While it is not a crystal ball and is still an emerging field not always covered by insurance, PGx testing is a powerful tool that holds the promise of dramatically shortening the painful trial-and-error process.3
Beyond the Genes (Biomarkers and Comorbidities)
Depression is not an isolated brain disease; it is a systemic condition with deep biological roots.
The process of “deconstructing depression” requires looking at the whole person and their interconnected biological systems.5
Three critical pathways are often implicated:
- Inflammation: A chronic, low-grade inflammatory state, driven by an overactive immune system, is strongly linked to depression. Elevated inflammatory markers called cytokines can disrupt the production of key neurotransmitters like serotonin and are also a known driver of metabolic conditions like Type 2 Diabetes, creating a vicious cycle between mood and metabolism.19
- HPA Axis Dysfunction: The hypothalamic-pituitary-adrenal (HPA) axis is the body’s central stress response system. Chronic stress can lead to its overactivation, resulting in persistently high levels of the hormone cortisol. This hypercortisolemia is toxic to the hippocampus, a brain region vital for memory and mood regulation, and also contributes to the development of insulin resistance.19
- Insulin Resistance: A state where the body’s cells don’t respond properly to insulin is now understood to be an independent risk factor for depression, even in the absence of diabetes.19
This biological reality means that a thorough medical workup is a non-negotiable part of a depression evaluation.
Before labeling a patient with “treatment-resistant depression,” a clinician must rule out or address underlying physical conditions that can cause or worsen depressive symptoms, such as thyroid disorders, autoimmune diseases, chronic pain, or heart disease.20
This deeper biological lens forces us to redefine the very concept of “treatment-resistant depression” (TRD).
Many cases labeled as TRD may not represent a failure of psychiatric treatment, but rather a failure of comprehensive diagnosis.
The “resistance” may not be an intrinsic property of the depression itself, but a consequence of an unaddressed biological driver—like chronic inflammation—or a simple pharmacogenomic mismatch where an ultrarapid metabolizer never achieved a therapeutic dose.
The label of TRD should not be a clinical dead-end; it should be a trigger for a more profound “soil analysis” to ensure the foundational diagnosis and treatment strategy are sound.
Pillar 2: Climate and Environment – The Power of Lifestyle and Context
A plant’s health depends not only on the soil but also on the climate and environment it lives in.
Similarly, mental health is profoundly influenced by the foundational pillars of lifestyle: nutrition, physical activity, and sleep.
These are not optional “add-ons” to treatment; they are the essential climate that determines whether healing can occur.
These pillars are deeply interconnected, and improving one often creates a positive cascade that benefits the others.23
Foundational Nutrition and The Gut-Brain Axis
The adage “you are what you eat” is scientifically true for mental health.
A diet high in processed foods, sugar, and unhealthy fats can fuel the very inflammation that drives depression.
Conversely, a diet rich in whole foods—fruits, vegetables, lean proteins, and healthy fats like omega-3s—provides the essential building blocks for neurotransmitters like serotonin and dopamine.
Furthermore, this type of diet supports a healthy gut microbiome.
The gut and brain are in constant communication via the “gut-brain axis,” and a healthy gut environment directly contributes to a healthy mind.25
Movement as Medicine
Physical activity is one of the most potent, evidence-based, and underutilized antidepressants available.26
Regular exercise works through multiple mechanisms: it boosts the release of mood-elevating endorphins, reduces levels of the stress hormone cortisol, and stimulates neurogenesis—the growth of new brain cells—particularly in the hippocampus, the same brain region damaged by chronic stress.25
The goal is not to become a marathon runner; aiming for 150 minutes of moderate activity, like brisk walking, per week has been shown to have significant benefits.26
The Restorative Power of Sleep
Sleep is the brain’s essential reset and repair cycle.24
The link between sleep and depression is powerfully bidirectional: poor sleep is a strong predictor of depression, and depression severely disrupts sleep patterns.25
Restoring healthy sleep is therefore a primary therapeutic target.
This can be achieved through practicing good “sleep hygiene,” which includes maintaining a consistent sleep-wake schedule, creating a cool, dark, and quiet sleep environment, and avoiding caffeine and heavy meals before bed.27
The Psychosocial Landscape
The “environment” also extends to our psychosocial world.
Factors like chronic life stress, financial instability, unresolved trauma, and a lack of strong social support can all exacerbate depression and create significant barriers to treatment efficacy.5
Addressing these external stressors is a critical part of a holistic treatment plan.
A patient’s lifestyle is not only a target for intervention but also a rich source of diagnostic clues.
A patient reporting chronic insomnia and a poor diet is providing vital information about their underlying biology.
By first addressing these foundational pillars—improving sleep, modifying diet, introducing exercise—the entire system can be stabilized.
This makes the “soil” more fertile for traditional treatments like medication and therapy.
When the baseline level of inflammation and stress is reduced, a medication may work more effectively, or a lower dose might prove sufficient, thereby minimizing the burden of side effects.10
Pillar 3: Choosing the Right Plants – A Tour of the Therapeutic Toolkit
Once the landscape architect understands the soil and climate, they can begin to select the right plants.
In depression treatment, this means choosing the right therapeutic tools—medications and psychotherapies—that are best suited to the individual’s unique profile.
The goal is not to find the one “best” plant, but to create a thriving, synergistic garden.
A Guide to Antidepressant Classes
Antidepressants primarily work by influencing the levels of key chemical messengers in the brain called neurotransmitters, including serotonin, norepinephrine, and dopamine.30
Different classes of drugs have different mechanisms of action, making them better suited for different symptom profiles and biological makeups.
Table 1: Comparative Overview of Major Antidepressant Classes
| Class Name | Mechanism of Action | Common Examples | Primary Clinical Uses/Niches | Common Side-Effect Profile |
| SSRIs | Selectively blocks the reuptake of serotonin, increasing its availability in the brain.2 | Fluoxetine, Sertraline, Citalopram, Escitalopram 33 | Most common first-line treatment for depression and anxiety disorders.31 | Sexual dysfunction, headache, nausea, insomnia, potential for QTc prolongation.2 |
| SNRIs | Blocks the reuptake of both serotonin and norepinephrine.30 | Venlafaxine, Duloxetine, Desvenlafaxine 32 | Depression, anxiety, and often used for co-occurring chronic pain conditions like fibromyalgia or neuropathy.31 | Nausea, dry mouth, dizziness, sweating; can increase blood pressure.30 |
| TCAs | Older class that blocks reuptake of serotonin and norepinephrine; also affects other receptors, causing more side effects.30 | Amitriptyline, Nortriptyline, Imipramine 32 | Often reserved for treatment-resistant cases due to side-effect profile; also used for pain and insomnia.34 | Dry mouth, constipation, blurred vision, weight gain, sedation, cardiac risks (QRS prolongation).30 |
| MAOIs | The oldest class; inhibits the monoamine oxidase enzyme, preventing the breakdown of serotonin, norepinephrine, and dopamine.30 | Phenelzine, Tranylcypromine, Selegiline 33 | Highly effective, but typically a last resort for severe, treatment-resistant depression due to safety concerns.34 | Requires strict dietary restrictions (avoiding tyramine-rich foods) to prevent hypertensive crisis; many drug interactions.31 |
| Atypicals | A diverse group with unique mechanisms (e.g., affecting dopamine, or acting as antagonists at specific serotonin receptors).30 | Bupropion, Mirtazapine, Trazodone 30 | Matched to specific symptoms: Bupropion for low energy/anhedonia; Mirtazapine for insomnia/poor appetite; Trazodone for insomnia.30 | Varies by drug: Bupropion can increase anxiety and has seizure risk; Mirtazapine causes sedation and weight gain; Trazodone causes sedation.30 |
The Essential Role of Psychotherapy
It is a critical error to view psychotherapy as passive “talk.” Evidence-based therapies like Cognitive Behavioral Therapy (CBT), Interpersonal Therapy (IPT), and Dialectical Behavior Therapy (DBT) are active, skills-based treatments that physically change brain structure and function.37
While medication can be invaluable for treating the
symptoms of depression, psychotherapy addresses the underlying thoughts, behaviors, and relationship patterns that often cause and perpetuate the illness.34
Companion Planting (Combination and Augmentation Strategies)
For individuals with moderate to severe depression, the evidence is overwhelming: the most effective strategy is often “companion planting”—combining medication and psychotherapy.
This synergistic approach consistently yields better outcomes than either treatment used alone.37
For cases that don’t respond to a single antidepressant, evidence also supports combining two different medications (e.g., an SSRI with mirtazapine) or augmenting an antidepressant with another agent, such as an atypical antipsychotic (e.g., aripiprazole) or a mood stabilizer (e.g., lithium).40
The most robust treatment plans create a dialogue between biology and psychology.
Medication can provide the biological lift—the increase in energy and cognitive clarity—that a person needs to fully engage in and benefit from the hard work of therapy.27
In turn, the skills learned in therapy give the individual the tools to manage life stressors and build resilience.
This reduces the chronic biological burden of stress (like high cortisol levels), which can prevent future relapses and, in some cases, may allow for medication to be successfully tapered over the long term.
This positive feedback loop, where biological and psychological interventions empower each other, is the hallmark of a truly integrated and effective treatment plan.37
Pillar 4: Tending the Garden – Long-Term Management and Special Cases
A garden, once planted, requires ongoing care.
The same is true for mental health.
The final pillar of the landscape architect’s framework involves the long-term, dynamic process of tending the garden, nurturing the therapeutic relationship, and knowing how to respond when challenges like treatment resistance arise.
The Therapeutic Alliance: The Architect’s Most Important Tool
The single most important tool in the architect’s kit may be the relationship with the client.
A strong, trusting, and collaborative doctor-patient relationship is not a “soft skill”; it is a robust predictor of successful treatment outcomes.11
The most effective alliances are built on a “mutual participation model,” where the clinician brings medical expertise, and the patient is respected as the expert on their own life, goals, and experiences.12
When a clinician takes the time to understand a patient’s personal context and how they frame their illness—for instance, recognizing when a patient links their depression to social or situational problems—they can offer more tailored and acceptable solutions, fostering better adherence and outcomes.43
Navigating Treatment-Resistant Depression (TRD): When the Garden Faces a Blight
Even in the best-tended gardens, problems can arise.
In psychiatry, this is often termed Treatment-Resistant Depression (TRD), formally defined as a failure to respond to at least two adequate trials of different antidepressant medications.20
Rather than a dead end, TRD should be seen as a signal to engage in a more systematic and intensive form of landscape architecture.
The approach involves several steps:
- Re-evaluate the “Soil”: The first step is always to go back to Pillar 1. Confirm the diagnosis is accurate. Thoroughly screen for and treat any underlying medical conditions or substance use issues that could be driving the depression.20 Re-assess and optimize all lifestyle factors. If not already done, consider pharmacogenomic testing to rule out a metabolic mismatch.18
- Optimize Treatment: Ensure that previous medication trials were of adequate dose and duration, as some patients simply need more time or a higher dose to respond.18
- Switch, Augment, or Combine: Systematically work through the medication strategies outlined in Pillar 3, such as switching to a different class, augmenting with a second agent, or trying a combination of two antidepressants.18
- Consider Advanced Neurostimulation: For severe and persistent cases, several evidence-based neurostimulation techniques can be highly effective. These include Electroconvulsive Therapy (ECT), Transcranial Magnetic Stimulation (TMS), and newer interventions like intravenous Ketamine or intranasal Esketamine. For the most intractable cases, Deep Brain Stimulation (DBS) is also an option.20
Conclusion: The Principles of a Thriving Garden
I think back to that young woman who felt so “unfixable.” Her journey was long, but her turning point came when we abandoned the “whack-a-mole” approach and adopted the landscape architect model.
A PGx test revealed she was an ultrarapid metabolizer of many common SSRIs, explaining why they had failed.
A comprehensive workup identified underlying inflammation, which we began to address with dietary changes.
She started a simple walking routine, which helped regulate her sleep.
With this more stable foundation, we introduced a medication that was a better fit for her metabolism, in combination with therapy to address the trauma that underpinned her depression.
Slowly, the garden of her mind began to thrive.
Her story is a testament to this new paradigm.
The quest to find the single “best antidepressant” is a misguided one that often leads to frustration and despair.
The true goal is to become a curious, compassionate, and collaborative landscape architect for your own mind.
It is a holistic and dynamic process of analyzing the unique ecosystem of your biology and life, choosing the right combination of tools for that specific environment, and engaging in the patient, ongoing work of tending the garden toward a state of lasting well-being.
Works cited
- Finding the Right Antidepressant – Depression Medication Trial and …, accessed on August 8, 2025, https://www.marieclaire.com/health-fitness/a20452/finding-the-right-depression-medication/
- Selective serotonin reuptake inhibitors (SSRIs) – Mayo Clinic, accessed on August 8, 2025, https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825
- A new paradigm for the prediction of antidepressant treatment response – PubMed Central, accessed on August 8, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC3181929/
- Navigating the Frustrations of Mental Health Medication Trial and Error: Is There a Better Way? – Temecula Medical Group, accessed on August 8, 2025, https://www.temeculamedicalgroup.com/blog/navigating-the-frustrations-of-mental-health-medication-trial-and-error-is-there-a-better-way
- A clinical approach to treatment resistance in depressed patients: What to do when the usual treatments don’t work well enough? – PubMed, accessed on August 8, 2025, https://pubmed.ncbi.nlm.nih.gov/33289425/
- Full article: Personalized medicine in psychiatry: ethical challenges and opportunities, accessed on August 8, 2025, https://www.tandfonline.com/doi/full/10.31887/DCNS.2009.11.4/kevers
- Personalized medicine applied to mental health: Precision … – Elsevier, accessed on August 8, 2025, https://www.elsevier.es/es-revista-revista-psiquiatria-salud-mental-486-articulo-personalized-medicine-applied-mental-health-S2173505015000400
- Depression From a Precision Mental Health Perspective: Utilizing Personalized Conceptualizations to Guide Personalized Treatments – Frontiers, accessed on August 8, 2025, https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2021.650318/full
- Public psychology and holistic approaches to prevention and treatment of depression, accessed on August 8, 2025, https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2025.1600094/full
- Integrating medicine with lifestyle for personalized and holistic healthcare – Alzeer, accessed on August 8, 2025, https://jphe.amegroups.org/article/view/9442/html
- [Severe depression : the doctor/patient relationship] – PubMed, accessed on August 8, 2025, https://pubmed.ncbi.nlm.nih.gov/20141794/
- Impact of the Doctor-Patient Relationship – Psychiatrist.com, accessed on August 8, 2025, https://www.psychiatrist.com/pcc/impact-doctor-patient-relationship/
- Genetic Testing for Mental Health Medications – Total Mental Wellness, accessed on August 8, 2025, https://totalmentalwellnessfl.com/genetic-testing-mental-health-medications/
- The Role of Pharmacogenetics in Personalizing the Antidepressant and Anxiolytic Therapy – PMC – PubMed Central, accessed on August 8, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC10218654/
- Personalized medicine in psychiatry: ethical challenges and opportunities – ResearchGate, accessed on August 8, 2025, https://www.researchgate.net/publication/41410531_Personalized_medicine_in_psychiatry_ethical_challenges_and_opportunities
- Pharmacogenomic Testing Brings Real-World Benefits for Depression Treatment – McGovern Medical School – UTHealth Houston, accessed on August 8, 2025, https://med.uth.edu/psychiatry/2025/04/28/pharmacogenomic-testing-brings-real-world-benefits-for-depression-treatment/
- Evidence Brief: The Comparative Effectiveness, Harms, and Cost-effectiveness of Pharmacogenomics-guided Antidepressant Treatment versus Usual Care for Major Depressive Disorder – NCBI, accessed on August 8, 2025, https://www.ncbi.nlm.nih.gov/books/NBK384610/
- Treatment-resistant depression – Mayo Clinic, accessed on August 8, 2025, https://www.mayoclinic.org/diseases-conditions/depression/in-depth/treatment-resistant-depression/art-20044324
- Deconstructing Diabetes and Depression: Clinical Context, Treatment Strategies, and New Directions | Focus – Psychiatry Online, accessed on August 8, 2025, https://psychiatryonline.org/doi/10.1176/appi.focus.20150040
- Understanding Treatment-Resistant Depression: Causes and Solutions, accessed on August 8, 2025, https://pavilionhospital.com/blog/treatment-resistant-depression-causes-solutions/
- Treatment-Resistant Depression | Johns Hopkins Medicine, accessed on August 8, 2025, https://www.hopkinsmedicine.org/health/conditions-and-diseases/mood-disorders/treatment-resistant-depression
- Treatment-Resistant Depression: What It Is & Symptoms – Cleveland Clinic, accessed on August 8, 2025, https://my.clevelandclinic.org/health/diseases/24991-treatment-resistant-depression
- The Connection Between Diet, Exercise, and Sleep – Sleep Foundation, accessed on August 8, 2025, https://www.sleepfoundation.org/physical-health/diet-exercise-sleep
- The Interconnectedness of Diet, Exercise, Sleep, and Mental Health – IM, accessed on August 8, 2025, https://im-health.com/the-interconnectedness-of-diet-exercise-sleep-and-mental-health/
- The Role of Lifestyle Changes in Mental Health: How Nutrition, Exercise, and Sleep Impact Your Well-Being – Principium Psychiatry, accessed on August 8, 2025, https://www.principiumpsychiatry.com/blog/the-role-of-lifestyle-changes-in-mental-health-how-nutrition-exercise-and-sleep-impact-your-well-being/
- The Link Between Mental Health and Exercise, Diet, and Sleep, accessed on August 8, 2025, https://cornercanyonhc.com/blog/the-powerful-link-between-lifestyle-changes-and-mental-health-exercise-diet-and-sleep/
- The Role of Exercise, Nutrition, and Sleep in the Battle Against Depression, accessed on August 8, 2025, https://www.fhpcc.com/the-role-of-exercise-nutrition-and-sleep-in-the-battle-against-depression
- Serial mediation effect of physical activity and sleep quality between dietary behaviour and depression symptoms: A nationwide cross-sectional survey, accessed on August 8, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC10979249/
- Deconstructing the mental health crisis: 5 uneasy pieces – PMC, accessed on August 8, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC4915930/
- Antidepressants – StatPearls – NCBI Bookshelf, accessed on August 8, 2025, https://www.ncbi.nlm.nih.gov/books/NBK538182/
- Types of Antidepressants and How They Work – Verywell Mind, accessed on August 8, 2025, https://www.verywellmind.com/what-are-the-major-classes-of-antidepressants-1065086
- Mechanism of Actions of Antidepressants: Beyond the Receptors – Psychiatry and Clinical Psychopharmacology, accessed on August 8, 2025, https://psychiatry-psychopharmacology.com/Content/files/sayilar/94/12_4_6.pdf
- Antidepressants: Types, side effects, uses, and effectiveness – Medical News Today, accessed on August 8, 2025, https://www.medicalnewstoday.com/articles/248320
- Antidepressants: What They Are, Uses, Side Effects & Types – Cleveland Clinic, accessed on August 8, 2025, https://my.clevelandclinic.org/health/treatments/9301-antidepressants-depression-medication
- Antidepressant – Wikipedia, accessed on August 8, 2025, https://en.wikipedia.org/wiki/Antidepressant
- Symptom Cluster-Matching Antidepressant Treatment: A Case Series Pilot Study – MDPI, accessed on August 8, 2025, https://www.mdpi.com/1424-8247/14/6/526
- Evidence-Based Applications of Combination Psychotherapy and …, accessed on August 8, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC6519650/
- Treatment – Depression in adults – NHS, accessed on August 8, 2025, https://www.nhs.uk/mental-health/conditions/depression-in-adults/treatment/
- Combining psychotherapy and antidepressants in the treatment of depression – PubMed, accessed on August 8, 2025, https://pubmed.ncbi.nlm.nih.gov/11313088/
- Combining antidepressants: a review of evidence | Advances in Psychiatric Treatment, accessed on August 8, 2025, https://www.cambridge.org/core/journals/advances-in-psychiatric-treatment/article/combining-antidepressants-a-review-of-evidence/10A101DFD409DCB1FDCBB951F391F7AE
- Combination Antidepressant Therapy Is More Effective Than Monotherapy for Acute Severe Depression and Nonresponding Depression | AAFP, accessed on August 8, 2025, https://www.aafp.org/pubs/afp/issues/2022/1000/poems-antidepressant-therapy.html
- Treatment-Resistant Depression – WebMD, accessed on August 8, 2025, https://www.webmd.com/depression/treatment-resistant-depression-what-is-treatment-resistant-depression
- What we talk about when we talk about depression: doctor-patient conversations and treatment decision outcomes – BJGP, accessed on August 8, 2025, https://bjgp.org/content/62/594/e55
- my.clevelandclinic.org, accessed on August 8, 2025, https://my.clevelandclinic.org/health/diseases/24991-treatment-resistant-depression#:~:text=Treatment%2Dresistant%20depression%20(TRD),Find%20a%20Doctor%20and%20Specialists
