Chronic resistant depression: concept and management issue

Depression is a complex diagnostic construct. By 2020 depression is projected to rank second most disabling and killer disease after heart disease. Almost half of all depressed patients are likely to suffer from some degree of treatment resistance. Use of electroconvulsive therapy should be considered before calling it treatment resistant. Patient not responding adequately require complete review. Comorbidity diminishes treatment response, worsen prognosis. Options are optimization of antidepressant monotherapy, switching to another antidepressant, augmentation and combination of two or more antidepressants. In maintenance phase cognitive therapy has advantage over medication. Transcranial magnetic stimulation is an investigative tool and holds promise for effective treatment of severe depression.