The management of treatment-resistant depression in the medically ill

Depression is a common problem in patients with medical illness. Comorbidity can increase the likelihood of treatment resistance and underscores the importance of thorough and definitive evaluation of all disorders. Treatment selections must be considered carefully to avoid significant side effects and drug-drug interactions. Metabolic pathways and effects on the identified organ system will guide the clinician's choice of antidepressant medication. Increasing numbers of alternatives and combinations will assist today's physician in treating depression in the medically ill patient effectively.