If the diagnoses is clinical there may be other factors in the personality
you are over look. Your patient is not responding and is totally bummed
out. Buspirone has a negative effect on me. I have suffered years of wrong
medications and not quite complete or accurate diagnosis.
Try Venlafaxine and definitely valium or zanax, your patient will love you
for it and whats the problem with zanax or valium?, afriad a severely
depressed person may start to enjoy a little out of life

I have a 20+ year history of dysthymia and major depression and have been
on the described combination with only minimal improvement.  I am now on
300 mg Luvox, 40 mg BuSpar, and 150 mg Tegretol.  I have had strong
responses (excess sleepiness) to the initial doses of anti-epileptics and
am on a lower dose as a result.  The BuSpar has been the most effective
anti-anxiety agent I have used.  I had several negative side-effects on
Lithium (weight gain, acne, dry mouth, speech problems, etc.) and fewer
positive effects than I have had on the Tegretol.  Luvox has helped with
the depression more than anything since an initial trial with Prozac in
1989.  I tend to respond to AD's for short periods of time followed by a
lack of effectiveness (after about 6 months to a year, so it is not just a
placebo effect).  Hope this is useful.

Mary