Introduction

Depression in certain types of individuals carry an increased risk of suicide, and the longer they go unsuccessfully treated, the greater the risk becomes. Treatment-resistant depression (trd) which for this discussion signifies a form of depression that does not readily fully respond to treatment, leaves its victim in continual suffering and vulnerable to a full relapse, with associated increased suicide risk. Treatment-refractory depression (TRD) is used to define a type of depression that for all intents and purposes shows no response to a series of adequately delivered treatments, leaving its victim to suffer the severe symptoms and disability of a full episode, as well as both depression related and realistic hopelessness. In the context of untreated high risk factors and increasing despair, as treatment after treatment fails to help, it is no mystery that either form accentuates the risk of suicide inherent in a high risk individual.

What forms of trd/TRD carry a high risk of suicide? One of the most common forms of trd/TRD is that with comorbid severe psychic anxiety (Fawcett et al., 1990). A number of studies have shown that comorbid anxiety symptoms such as panic attacks, phobias, and obsessional symptoms have poor treatment outcomes compared to uncomplicated depression, both in terms of requiring more treatment courses, and more use of multiple medications to attain response, with partial response (trd) as a common outcome, and a related higher rate of relapse (Clayton et al., 1991).