Selecting appropriate treatment for patients who are nonresponsive to initial therapy

Depression can be a chronic illness, and several treatment steps are often needed to achieve sustained symptom remission and return patients to premorbid levels of functioning. Patients with chronic depressive illness, early onset, concurrent psychiatric or medical conditions, difficult psychosocial problems, or comorbid melancholic and anxious features may require additional treatment steps. Next-step strategies, after optimizing the dose and extending the treatment trial of the initial antidepressant, include switching antidepressants, adding another antidepressant, and augmenting with a nonantidepressant agent.