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It is a refractory depression. There are a few pieces of evidence to show that dopamine agonists like Pramipexole may help in such cases.
1. Adding Bupropion (Ethyl cellulose aqueous dispersion (NF), glyceryl behenate, methacrylic acid copolymer) to SSRI (selective serotonin reuptake inhibitors).
2. Mirtazepine (Colloidal silicon dioxide, Corn starch, Hypromellose, Lactose monohydrate, Magnesium stearate) plus Venlafexine (Sodium starch glycolate, Povidone, Magnesium stearate, Ferric oxide yellow).
3. MAO (Monoamine oxidase) inhibitors like Tranylcypromine (Calcium sulfate dihydrate, Erythrosine).
4. Dopamine agonists like Pramipexole (Pramipexole dihydrochloride monohydrate) are added to antidepressants.
5. Concurrent CBT (Cognitive behavioral therapy) sessions.
6. Augmentation with Aripiprazole.
7. Augmentation with lithium.
8. Adding Olanzapine Fluoxetine combination.
I hope this helps.
Investigations to be done:
Erythrocyte folate levels test.
Vitamin D levels.