[Therapy resistance to antidepressive drugs: risk factors and treatment possibilities]

Resistance to antidepressants is a relevant clinical problem, especially under inpatient treatment conditions. Based on an extensive review of the literature, risk factors and treatment strategies are described. Beside an adequate dose regimen with the control of serum levels several other strategies are quite well empirically proven: change of the mode of action of the antidepressant, co-medication of an antidepressant with lithium, thyroid hormone (T3) or an MAO inhibitor, respectively. In case of delusional depressions the combination of an antidepressant with a neuroleptic, starting with the beginning of the treatment, can be recommended. Under certain conditions special psychotherapeutic activities should be started early enough. The treatment strategy of patients resistant to the usual antidepressive treatment should follow a systematic regimen and each step of this scheme should follow the other in intervals as short as possible. With respect to this regimen the ECT should not be considered too late.