Major depression is a very common illness encountered in psychiatric practice. A difficult challenge in the treatment of major depression/ bipolar depression is the management of treatment resistance. We frequently see patients who are treatment-resistant being prescribed various mood stabilizers, including anticonvulsants, second-generation antipsychotics, as well as lithium. Lithium has a major role in the maintenance treatment of bipolar illness and adjunctively in recurrent unipolar depression.1 Patients who do not respond completely to psychophar-macological approaches may require somatic treatment, including elec-troconvulsive therapy (ECT). ECT performed with concomitant anticonvulsants, antidepressants, and lithium remains controversial.
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