Inadequate response to antidepressants or psychological interventions is not uncommon among patients seen in clinical practice. This article reviews possible biological and psychosocial causes of poor response in people with depression and discusses options for management.
- Initially ensure that patients with depression have received an adequate dose and duration of appropriate treatment, be that antidepressants and/or psychological treatment.
- Review ‘treatment-resistant’ patients for possible causes of a poor response to treatment.
- There are a number of well-studied treatment options for patients who do not respond to initial simple antidepressant treatments.
- As some of the options recommended in this article are not widely used in primary care, GPs should have a low threshold for referring such patients to a psychiatrist experienced in difficult-to-treat depression.