Pharmacological treatment of resistant depression: an overview

Depressed patients referred to psychiatrists have nearly always failed to respond to first-line treatment with antidepressant medication. Subsequent care by the psychiatric team will involve a comprehensive care package; however, for most patients the adjustment of antidepressant medication will also play an important role.

The use of medication in treatment-resistant depression has benefited from the availability of an increasing number of antidepressant drugs. However, the evidence base for treating resistant depression is modest. Furthermore, it is difficult to produce treatment algorithms that can be broadly applicable; each patient must be treated as an individual and a collaborative approach pursued.

The pharmacological approach to treatment-resistant depression (TRD) is a vast subject area and one that we could not possibly cover in depth here. The aim of this module is to provide an overview of the subject. We start with relatively simple interventions such as switching within and between antidepressant classes, and move on to treatment combinations with both antidepressants and adjuncts such as lithium. The roles of electroconvulsive therapy (ECT) and cognitive-behaviour therapy (CBT) are also considered.

We hope that this module will help general adult and old-age psychiatrists gain confidence in the innovative use of pharmacological treatment in resistant depression, and thereby help patients with this debilitating condition to achieve better outcomes.