ABSTRACT
There is no generally accepted evidence-based sequence for antidepressant
interventions. However, there is agreement that several strategies should be
considered. These include optimization, switching, augmentation and combi-
nation strategies (Figure 7.1). Until recently, no single large trial had been
carried out to compare many of these options. This chapter will review results
from the first such trial published in 2006 on sequential treatments and
extend the discussion to other treatment options, including the role of atypi-
cal antipsychotics. Neuromodulatory therapies including electroconvulsive
therapy (ECT) and other somatic treatments also have an important role to
play in treatment-resistant depression (TRD) and are discussed in Chapter 8.
