The first step is to make sure that what is happening is really a treatment-resistant depression. Its diagnosis must be exact; we must never offer treatment blindly. It is necessary to rule out other conditions, for example, anemia, hypothyroidism and other hormonal disorders that may account for symptoms.
Within mental pathology, it is necessary to differentiate depression from anxiety, a personality disorder or bipolar disorder, for which antidepressants will not only be ineffective, but can worsen the situation. We also have to make sure that past therapeutic attempts lasted for an adequate duration (for antidepressants, six weeks) and had good adherence (between 30% and 50% of patients do not take their treatment correctly).
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