REFRACTORY DEPRESSION.

Refractory depression is a poorly defined illness involving the persistence of symptoms of major depression or dysthymia over a prolonged period of time despite attempts at medical and psychotherapeutic intervention. The authors present a review of literature relevant to defining, evaluating and treating refractory depression. Medical illnesses, medications and substances of abuse may cause refractory depressions that fail to respond to conventional or extra­ordinary treatments. Numerous medication strategies including the use of tricyclic and monoamine oxidase inhibitors, lithium, bright artificial light and electroconvulsive therapy constitute the major medical interventions available. Psychotherapies include cognitive, interpersonal, marital, psychoanalytic and group approaches. The clinician dealing with chronically depressed patients must be familiar with most of these diagnostic and treatment approaches in order to plan an effective long-term intervention strategy for helping the patient to deal with the demoralization and seemingly overwhelming life stresses that frequently occur in refractory depression. [ABSTRACT FROM AUTHOR]