The PMHNP is treating a 45-year-old woman with a 30-year history of treatment-resistant depression who has tried every available medication, with little success. Today, the patient states that she is having suicidal ideation but has no plan. Which treatment option would the PMHNP discuss with her?

Choice A reason: Electroconvulsive therapy (ECT) is the most effective treatment for severe, treatment-resistant depression, particularly when multiple medication trials have failed. ECT can rapidly reduce suicidal ideation and depressive symptoms and is indicated in cases where there is high clinical urgency. Choice B reason: Exposure therapy is primarily used to treat anxiety disorders, phobias, and PTSD, not major depressive disorder, and would not be effective in this context. Choice C reason: Support groups provide emotional support and social connection but are not sufficient as a primary intervention for severe, treatment-resistant depression with suicidal ideation. Choice D reason: Exercise can improve mood and has adjunctive benefits for mild to moderate depression, but it is not an effective treatment for severe, chronic, or treatment-resistant depression, especially with suicidal ideation.