Use of Atypical Antipsychotics: Observations From Clinical Practice

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A psychiatrically well-informed internist colleague recently referred a patient with persistent depression for whom he had prescribed, in a stepwise fashion, a sensible combination of venlafaxine, bupropion, and risperidone. The antidepressants were at reasonable but not quite maximal doses. His question concerning this patient with nonmelancholic, nonpsychotic, recurrent unipolar depression: should he increase risperidone further, or push bupropion or venlafaxine?