A 48-year-old woman with treatment-resistant depression has failed three adequate antidepressant trials and two augmentation strategies. Her PHQ-9 remains at 21. She has no psychotic features and is medically stable. Her provider presents multiple next-step options including intranasal esketamine, ECT, and a novel augmentation strategy. The patient expresses feeling overwhelmed by the choices and asks the provider to just decide for her. What is the most appropriate approach?