Effexor is not a last-chance drug...In fact, it's usually prescribed in the 2nd or 3rd tier of the various "Treatment Resistant Depression" algorithms in the US

I've spent the last couple months looking for a last-chance drug because after 30-years of psychotropic medications and "off label" medications for depression absolutely NOTHING works for me.

Before going to the "Heavy Hitters" below, psychiatrists should have tried adding Lithium to a combo and consider ECT and Ketamine.

Here are a few options for severe drug resistant, unipolar depression after everything else has failed:

Emsam/ Selegiline- a weak MAOI
(personally, I'm not going to waste my money on this one)
Mirapex- Pramepexiole
T3- Triiodothyronine
Parnate-MAOI
Nardil-MAOI

Anyone know of any other drugs available in the US? I'm out of ideas at this point?