Speaker Notes
- Emphasize VAST-D trial for aripiprazole
- Why switching is less effective (treatment failure ≠ wrong drug)
- Combination therapy as preferred strategy
💡 Teaching Point: "Treatment-resistant" often means "combination-naive"
Q: "What if patient failed SSRI + mirtazapine?" Hard
Consider atypical antipsychotic augmentation. Quetiapine or aripiprazole both evidence-based. Monitor metabolic effects.