Established Treatment Strategies
While there is some evidence that anti-depressant pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) may be effective in treating PMD, patients with PMD often do not respond to monotherapy and require a combination of anti-depressant and anti-psychotic medication.
Electroconvulsive therapy (ECT), along with combination antidepressant-antipsychotic treatment, is the other established treatment of PMD. ECT may have a more reliable track record in improving symptoms than pharmacological treatments. However, the stigma, cost, and cognitive side effects often make it a second or third line treatment except in special circumstances. For example, if a patient's PMD is imminently life threatening as a result of suicide risk or cachexia, ECT may be considered first line treatment. In addition, a patient who cannot tolerate medications, or has responded more favorably to ECT in the past, may be considered for ECT first.
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