DBS and ablative psychosurgery are strategies for patients with the most severe and intractable illness. What approaches are available to other patients? Pharmacologic treatments for treatment-resistant depression include selective serotonin reuptake inhibitors and heterocyclics, other antidepressants (such as bupropion and serotonin-norepinephrine reuptake inhibitors, mood stabilizers, and dopamine agents), in addition to a number of experimental agents, such as pindolol, inositol, stimulants, and omega-3 fatty acids (7). Nonpharmacologic treatment strategies include psychotherapy, ECT, vagus nerve stimulation, and repetitive transcranial magnetic stimulation. Response and remission rates are substantially below those of standard treatments for non-treatment-resistant depression.