Treatment of refractory primary depression

Refractory depressions are depressions that respond insufficiently to treatment with the standard antidepressants, given long enough and in adequate dosage. If tricyclic antidepressants or selective serotonin reuptake inhibitors are insufficiently efficacious, an augmentation strategy may be applied. Drugs with a reinforcing effect on antidepressant medication are lithium and possibly liothyronine (triiodothyronine). If the results are nil or insufficient, administration of MAO inhibitors may be resorted to. Finally, electroconvulsive treatment may be administered to patients with a vital depression. If in depression there are indications of personality disorders and/or stressful life situations, treatment should comprise not only antidepressants but also psychological intervention and psychosocial measures.