This article describes a highly selective constellation of the more un
ique strategies for managing the treatment-resistant patient. As each
successive move down the treatment algorithm flowchart becomes necessa
ry, the risk/benfit ratio may shift toward less well-substantiated, bu
t still biologically informed, strategies. Although some of the more u
nusual treatments described in this article represent minimally charte
d territories, the more promising techniques deserve further explorati
on.