Treatment-resistant major depression in children

Treatment-resistant major depression is defined as depressive symptoms that persist despite using an effective dose of at least 2 antidepressants as sequential monotherapy, each for a minimum of 4 weeks. Consider if any of the reasons for antidepressant nonresponse listed in Key questions to assess nonresponse to an antidepressant for major depression could account for poor response; if not, refer the child to a child psychiatrist, or an age-appropriate mental health service for multidisciplinary input. Other antidepressants that may be considered by psychiatrists include tricyclic antidepressants, mirtazapine, venlafaxine and monoamine oxidase inhibitors (MAOIs); however, evidence of their efficacy is minimal and drugs from these classes are usually only used in adolescents.