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A 74-year-old woman has been an inpatient for five weeks with a severe depressive episode. She has completed adequate trials of sertraline and then venlafaxine at the maximum doses she could tolerate. She now sits motionless for hours, whispers a word or two when pressed, and is taking almost nothing by mouth; she has lost 11 kg and her urea is climbing. Nothing shifts her mood, not even her great-grandchild being brought to the ward. There are no delusions or hallucinations. She understands what is proposed and can consent to treatment. Which one of the following treatments should now be offered?
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