[Pharmacological treatment of resistant depression]

This article will review the evaluation and treatment of the resistant depressed patient. Although most depressives improve rapidly, a relatively small group is resistant to acute treatment. For resistant depression the first strategy must be thorough reassessment. This will include review of the diagnosis and the type of previous treatment. Defining adequacy of treatment is not always an easy task, and inadequate antidepressant trials are a relatively common phenomenon. Various treatment options include: augmentation, combination, and switching; the vast majority of available evidence on the efficacy of augmentation with lithium and thyroid supplementation indicate a remarkable degree of consistency in concluding that is effective; there is limited evidence, mostly provided by uncontrolled studies, supporting the efficacy of combining antidepressants; options of switching to a different monotherapy (to other antidepressant) are reviewed. Different strategies may be efficacious in the treatment of resistant depression; however, further randomized controlled trials with larger sample sizes are required to demonstrate the efficacy of options of treatment-resistant depression.