MAOIs can be helpful in TRD. Many years ago, I took Parnate for a while and did have some lightening of my depression. Unfortunately, I also had issues with dramatic blood pressure drops and had to stop taking it. You're probably aware that there are some pretty drastic food restrictions with the MAOIs. These basically just mean that you have to be very aware of what you're eating. I remember that I accidentally ate some dill dip at a family gathering, forgetting that it included sour cream, which is on the restricted foods list for MAOIs. I got a bit panicky about it, but I apparently hadn't eaten enough to cause problems.

Has your doctor tried you on any combination therapies, where you take a less conventional drug long with a traditional antidepressant? I had the most success with modafanil (Provigil) or Nuvigil, but my current insurance will not cover it now, and even the generic is several hundred dollars a month. I currently take a low dose of Adderall, but that hasn't been helpful at any dose, and I'll be discontinuing it when I see my pdoc later this month. I've also been tried on risperidone (Risperdal), lamotrigine (Lamictal), and Abilify. All of these were attempted in addition to an antidepressant, and while only the Provigil was successful for me, any of them might work for you. This treatment approach might be worth exploring if you've never tried it.

You might also ask your doctor about an older drug called doxepin, which was marketed in the US as Sinequan. This was relatively helpful for me and worked wonders for some other TRD patients I know.

It's a struggle, I know, but there are probably some avenues left for you to explore. Sometimes the hardest thing is to keep your doctor engaged in the fight, so it's good to hear that yours is willing to step off the well-worn SSRI path.