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Treatment-resistant depression — MCCQE Part 1 MCQ

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HardDepressionTreatment-resistant depressionMCCQE Part 1

A 60-year-old man failed three adequate SSRI/SNRI trials. Persistent suicidal ideation, severe anhedonia, 10kg weight loss. On max-dose venlafaxine without response. Most appropriate next step?

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Correct answer: A — Electroconvulsive therapy (ECT)

Treatment-resistant depression with severe features: ECT has highest remission rates (50-70%). Indicated for acute suicidality, psychotic depression, failed multiple trials. Clozapine is for treatment-resistant schizophrenia.

Reference: CANMAT Treatment-Resistant Depression