Refractory depression is one of the premier challenges faced by clinicians treating hospitalized depressed patients. Twenty percent of depressed patients do not respond to an initial adequate antidepressants. Depression in the elderly presents specific problem sindifferential diagnosis and treatment The course of later-life depression is often characterized by frequent and prolonged relapse and achronic outcome. The physician is thus faced with a difficult set of treatm ent issues involving reassessment of diagnosis and the course of illness and consideration of adjustment and alternative treatment We describe a case of an elderly with a history of refractory depression who did not responded to adequate pharm acotherapy, such as heterocyclic antidepressants, augm entations with lithium or thyroid hormone and a monoamine oxidase in hibitor and electroconvulsive therapy.
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