I am writing out of concern for a family member (pseudonym 'Pat') who is reaching the end of the standard list of treatment options following a major crash in December after tapering off Paxil.

Pat's currently at an out-of-state facility that can administer ECT. They are only about 4 treatments in, and while the first 2 seemed promising, Pat's been drowning in suicidal thoughts for the 5 following days straight, including the most recent 2 days (which included the most recent treatments). There is a tiny blip after an ECT session that lasts for a few hours, and then a crash that lasts until the next treatment.

We are trying to collectively work out how to think about "what's next" if this course of treatments doesn't prove effective.

My dumb question is: is there a specific facility or region of the country where we could consider going that would be considered to have a strong approach to working through this very difficult road?

From reviewing a lot of posts here and extensive Google sessions, I'm not getting the sense that there is such a place or region. Maybe the Mayo Clinic in Minnesota?

Pat's in Montana, and we have family in Arizona, Washington, and Indiana.

None of us feel that we've been able to trust a single professional we've found yet so far.

Any thoughts or discussion are welcome.