"Entire Spectrum of Treatment" Dr. Fieve: "If you look at all the drug studies, the amount of improvement on the antidepressant drugs is probably around 70%, the amount of improvement with improvement with placebo is probably around 45 to 50%, so you've got a window of about 20%, but with this window, and with a certain skill you can still get people that are in terrible, terrible shape, rehabilitated in fairly fast order. I'll start out with one course of antidepressants, and I'll probably start out with the SSRIs, I'll probably give that for 3,4,5 weeks, and I bring it up to a high level fast, and I get discouraged if the patient doesn't get better in 3 or 4 weeks. So then I go on to antidepressant 2, that'll be of a different biochemical nature, it's not gonna be a SSRI, it could be a dopamine inhibitor, it could be a dual drug, and in this case, the patient is getting the benefit of a seratonin, re-uptake inhibitor, and a nor-epinephrine re-uptake inhibitor, so the spectrum that it should be able to treat, is larger than the spectrum with just one mechanism of action. Then we finally have, if the patient is failing on all three of these, then I'll go on to a MAO inhibitor. These drugs will oftentimes pull a patient out that none of the other three categories of drugs will. Beyond that, if you've still got a patient that is treatment resistant, we now have to say, is there anything left. You got a seriously depressed patient, doesn't like to get out of bed much, suicidal, you've got trans-cranial stimulation, that's the thing that they put in the back of your head, you sit in a chair, and you get treatments for that, or you got electric shock treatment, and that's the entire spectrum of treatment for depression."