Strategies for treatment-resistant depression

Clinical depression is a common disorder with serious implications that is often misdiagnosed or underestimated. More than 50% of suicides are associated with a major depressive disorder, and depression can adversely impact a variety of other medical conditions. Although > or = 70% of depressions can respond to appropriate medications, few patients actually receive adequate medical therapy. This article reviews the definition of adequate therapy for depression, discusses common comorbid conditions, and examines the issue of true treatment resistance. Practical strategies for treatment-resistant depression, including switching classes of antidepressant drugs, combination therapy, augmentation strategies, and somatic therapies, are incorporated into a treatment algorithm.