Background: The best treatment approaches for chronic severe refractory depression remain uncertain. This study aimed to identify short-term outcome and most successful somatic treatments of severe refractory depressives referred to an affective disorders service.
Methods: Patients with chronic refractory depression referred to a specialist affective disorders service over a 10-year period were studied. Using detailed case records of the index episode, courses of treatment and outcome were examined.
Results: Patients were predominantly middle-aged females with few prior episodes but long index episodes. Patients received higher antidepressant doses and more combinations on the specialist service. Very-high-dose antidepressants (tricyclics, velafaxine or tricyclic--MAOI combinations), usually augmented with lithium and often combined with ECT, were the most effective somatic treatments. Most subjects improved substantially, but few reached premorbid levels.
Limitations: The study was retrospective. Treatment courses were sequential rather than random.
Conclusions: Refractory depression is responsive to vigorous somatic therapy, although most patients continue with some symptoms.