Treatment Resistant Depression.

Mr Patra, a 64-year-old retired Coal India employee, presented with persistent low mood, no interest in daily activities, talking to people, or physical activity, plus reduced appetite, weight loss, and insomnia. He also has a hiatal hernia and GERD. In 2016, he had repetitive thoughts and sleeplessness, managed for four years with Fluoxetine 20 mg, Clomipramine 25 mg, and Lorazepam 2 mg. In 2020, an ischemic stroke (PCA territory) triggered a relapse of depression. Prior meds failed; Fluoxetine rose to 80 mg (no effect), Escitalopram 20 mg (ineffective), Venlafaxine 75 mg with Bupropion 300 mg (helped but stopped due to gastritis), and Mirtazapine (unhelpful). Lorazepam dependence persists despite trials of Clonazepam, Diazepam, Melatonin, and Trazodone. For four years, refractory GERD, on Esomeprazole and Levosulpiride, continues. Currently, he has ongoing low mood, disinterest in socializing and activity, poor appetite, weight loss, and insomnia, with treatment-resistant depression.