[When depression does not end. Resistant depression: recent clinical and therapeutic aspects]

All over the world, depression represents a major public health issue. According to WHO, it is the fifth disease in the world (in years of illness), the second for people aged 15 to 44 and by 2020, it could become the second in the whole world population after cardiovascular diseases. Although increasingly safer and more efficient antidepressants are available, physicians are frequently confronted with the problem of resistant depression. Indeed, an estimated 30 to 45% of patients treated for major depressive disorder have either a partial response or no response at all to the antidepressive treatment. Residual symptoms are very common. Besides usual strategies such as lithium or thyroid hormones adding, some new approaches are now being used to improve the treatment of resistant depression. These are in particular pharmacological strategies such as switching or augmentation, psychotherapy and cerebral stimulation technology. This article reviews the latest clinical and therapeutic aspects of resistant depression.