Abstract
The diagnosis and treatment of refractory mood disorders were reviewed with special focus on depression. Refractory depression is generally defined when adequate treatment with antidepressants fails. Recent neuroradiological studies have shown that cerebral atrophy mainly in the temporal lobe, subcortical small infarcts and reduced cerebral blood flow are frequently observed in patients with refractory depression. Switching to another class of antidepressant, augmentation with lithium or thyroid hormone, or electroconvulsive therapy is used for the treatment. Prospective studies based on treatment algorithms are required to establish standard treatment of refractory depression.
