A RATIONAL APPROACH TO THE NON-RESPONDING DEPRESSED PATIENT

At least 30% of patients with major depression fail to respond to conv entional antidepressant medication, even when given adequate doses. Nu merous factors have been implicated in treatment resistance including subclinical hypothyroidism, alcohol abuse, occult carcinoma, minor hea d injuries and the use of calcium channel blockers such as nifedipine. Lithium augmentation of traditional tricyclic antidepressants and sel ective serotonin re-uptake inhibitors such as fluoxetine are the most extensively investigated combinations used to treat non-responsive dep ression. Other strategies are also briefly discussed.