Importance of psychiatric support during follow-up

Major depressive disorder, especially in its severe or refractory forms, involves a significant deterioration in the quality of life of those who suffer from it. Affective symptoms such as persistent sadness, anhedonia, apathy, or irritability are combined with cognitive symptoms (slow thinking, guilt, hopelessness, suicidal thoughts), somatic symptoms (insomnia, hypersomnia, changes in appetite, decreased vitality), and psychotic symptoms (delusions, hallucinations).

This set of symptoms has a profound effect on the patient's functioning, productivity, and personal relationships. Therefore, ongoing psychiatric support is an essential pillar of treatment, relapse prevention, and comprehensive patient recovery.

Monitoring and adjustments to pharmacological treatment

The clinical course of depression can fluctuate between acute phases, remission, relapses, and recurrences. In patients with severe symptoms, pharmacological treatment must be carefully monitored by a psychiatrist, who will be responsible for adjusting doses, evaluating therapeutic response, and preventing side effects (such as weight gain, sexual dysfunction, or metabolic syndrome).

In cases of refractory depression—when there is no remission after at least two adequate treatments in terms of dose and duration—augmentation strategies should be considered, combining antidepressants with atypical antipsychotics (aripiprazole, quetiapine), lithium, thyroid hormone, or stimulants such as modafinil or lisdexamfetamine. Without specialized support, many of these treatments are not administered correctly or are discontinued before achieving their therapeutic effect.

Management of complex cases and neuromodulation therapies

When pharmacological strategies are not sufficient, the role of the psychiatrist is even more crucial. Neuromodulation therapies such as transcranial magnetic stimulation (TMS), intravenous ketamine, or, in more resistant cases, electroconvulsive therapy (ECT) are evaluated.

These options require rigorous clinical assessment and follow-up and are generally administered in specialized centers under psychiatric supervision. In addition, in the management of complex clinical cases, psychiatric intervention coordinates multiple resources (pharmacological, neuromodulation, psychotherapy) in a personalized manner, increasing the chances of remission even in chronic and severe depression.

Suicide risk reduction and medical comorbidity

Psychiatric support is also key in the ongoing assessment of suicide risk. Systematic exploration of suicidal and self-harming thoughts allows i