Treatment resistance is not a unitary phenomenon but in mood disorders reflects issues of diagnostic subtypes, comorbidity, and treatment adequacy, augmentation, and alternatives. In clinical practice, therefore, it is not surprising that therapeutic approaches vary across practitioners and patients. In general, initial choices in the treatment algorithm are best drawn from options with the most support from clinical research and reports. What most experienced clinicians learn, however, is that therapeutic optimism in the pursuit of additional therapeutic options frequently yields benefits for patients with previously resistant disorders in the form of partial or full restoration of well-being and function. Although the focus in this section has been on the use of somatic therapies in patients with treatment-resistant mood disorders, it is important to consider that the addition of psychotherapy is frequently beneficial in these patients and should be included among the treatment approaches.
Revision date: July 8, 2011
Last revised: by Andrew G. Epstein, M.D.