Explain treatment-resistant depression and next-step options — CASC communication station

Open and agenda-set. Name time; ask her main worries first (lithium stigma, ECT fear, online ketamine). [3]

Explain TRD. "Treatment-resistant depression means depression that has not got much better after two proper full-dose medicine trials done for long enough with good adherence. It is a medical description of how treatment has gone so far — it is not a judgement that you are weak or 'beyond help'. Many people still improve with the next steps." [4][3]

Explain lithium. Lithium can be added to an antidepressant to boost benefit even when someone does not have bipolar disorder. We use blood tests to keep the level safe, and we check kidney and thyroid function. Early side-effects can include tremor or thirst; dangerous toxicity signs (severe tremor, confusion, vomiting, unsteadiness) need urgent care — especially if dehydrated. We review mood scores regularly.[1][3]

ECT. If depression becomes life-threatening, psychotic, or still severe despite further steps, ECT is a hospital treatment under anaesthetic with good evidence for severe depression. Temporary memory side-effects can occur; we discuss risks and benefits carefully — it is not a punishment and not random "scrambling."[2]

Online ketamine. Medical ketamine/esketamine, where available, is given in monitored settings because of blood pressure changes and dissociation. Unregulated internet products are unsafe; we can discuss licensed specialist pathways if appropriate later.[3]

Safety. If passive thoughts become plans or intent, contact crisis services/emergency the same day. Book early review; provide written information. Teach-back close. [3]