Abstract：
Treatment-resistant depression is a complex condition often requiring specialist psychiatric care. Many different psychiatric, physical and social factors can lead to a poor response to initial treatment of depression, and a careful assessment is required to determine the most appropriate management option. This can be particularly complex in the older population, who often have multiple physical and social comorbidities. We have used a fictional case to illustrate this, alongside an anonymised vignette of someone with personal experience of this condition. We have also provided an overview of the current evidence for treatment options, as well as a discussion of potential aetiological factors. By the end of this article, readers should understand the ambiguity of this diagnostic term, the aetiological factors that need to be assessed and the rationale for the treatment options available. They should be able to recognise how these ideas apply to the geriatric population.
摘要：
难治性抑郁症是一种复杂的疾病，通常需要专门的精神病治疗。许多不同的精神病，身体和社会因素会导致对抑郁症的初始治疗反应不佳，并且需要仔细评估以确定最合适的管理方案。这在老年人群中可能特别复杂，他们经常有多种身体和社会合并症。我们用一个虚构的案例来说明这一点，旁边是一个有这种情况的个人经验的匿名小插图。我们还概述了目前治疗方案的证据，以及对潜在病因的讨论。在本文的最后,读者应该理解这个诊断术语的模糊性，需要评估的病因学因素以及现有治疗方案的合理性.他们应该能够认识到这些想法如何适用于老年人群。
