Levine S
Acta Psychiatr Belg. 1986 Mar-Apr;86(2):141-51.
Between 10 and 30% of depressed patients, mostly bipolar, develop a therapy-resistant illness. The known causes of such chronic evolutions are discussed: misdiagnosis (underlying schizophrenia, personality disorder or dementia), drug-induced depression (neuroleptics), systemic disease (hypothyroidism, multiple sclerosis, cardiovascular or neoplastic disease etc.), or lack of efficacy (drug compliance, insufficient dosage). Remedies are suggested: adequate dosage, drug combination (Newcastle cocktail. tricyclic antidepressant + MAOI, imipramine + T3), carbamazepine in lithium-resistant cases, alprazolam, reduction in vanadium intake, sleep deprivation, psychosurgery.
10%至30%的抑郁症患者（大多为双相情感障碍患者）会发展为难治性疾病。本文讨论了此类慢性病程的已知病因：误诊（潜在的精神分裂症、人格障碍或痴呆）、药物性抑郁（抗精神病药物）、全身性疾病（甲状腺功能减退、多发性硬化症、心血管疾病或肿瘤疾病等）或疗效不佳（药物依从性、剂量不足）。文中还提出了一些治疗方法：适当剂量、联合用药（纽卡斯尔合剂：三环类抗抑郁药+单胺氧化酶抑制剂、丙咪嗪+三碘甲状腺原氨酸）、锂盐耐药病例使用卡马西平、阿普唑仑、减少钒摄入量、睡眠剥夺、精神外科手术。
