Hello @cizzo :)

How great to see you here! Please note, that even when clients present symptoms that place them in the severe depression category they don't necessarily need to undergo medication. It all depends on the set of symptoms exhibited, as long as they are not those that endanger the individual, some people can have even severe depression reversed without medical intervention.

But please, let me just say this: your insight is simply wonderful! It actually made me smile :)
YES! In some cases the medication do act as a 'kick starter' that even helps the client to engage more efficiently with their therapist!

Moreover, as you said, there are cases in which people just do not respond to any kind of drug (tricyclics, SSRIs or MAOIs). They are known to suffer from intractable depression. In such cases electroconvulsive therapy is considered to alleviate symptoms; but it's mostly adopted in suicidal patients.

Thanks for stopping by!
Best.