Journal of Affective Disorders 54 (1999) 287–294 Brief report Outcome in refractory depression a b c c b, * S.S. Shergill , M.M. Robertson , G. Stein , M. Bernadt , C.L.E. Katona a Institute of Psychiatry, London, UK b University College London, Medical School, Wolfson Building, 48 Riding House St., London W1N 8AA, UK c Farnborough Hospital, Farnborough, Kent, UK Received 4 September 1997; accepted 28 July 1998 Abstract Background: Failure to respond to first-line antidepressant treatment can occur in up to 40% of patients with depressive illness. A proven strategy for managing this refractory depression is lithium augmentation. The long-term outcome and optimal management of patients treated with lithium augmentation remains unclear. We describe a 4–8 year naturalistic follow-up of patients treated with lithium augmentation in two controlled studies of its efficacy in refractory depression. Method: Cases were followed up with personal interview where possible, and by telephone and general practitioner contact otherwise. Lifetime clinical status was ascertained using the Schedule for Affective Disorders and Schizophrenia-Lifetime (SADS-L). Results: We obtained outcome data on 53 of the original eligible 76 patients. There was a good outcome in 38 (72%) patients. Good outcome was associated with a less endogenous nature of depression and an absence of previous hospitalisations. Conclusions: There do not seem to be any specific prognostic indicators of long-term outcome to lithium augmentation beyond those recognised to be relevant in the outcome of depression generally. Limitations: The conclusions are limited by incomplete follow-up of the total original sample and lack of objective illness and medication data for the intervening period.  1999 Elsevier Science B.V. All rights reserved. Keywords: Resistant depression; Lithium augmentation; Outcome 1. Introduction and Davis, 1969). Indeed, up to 20% of patients with major depression who seek treatment have not Up to 40% of patients treated for depressive recovered after 2 years (Keller et al., 1984) and 12% illness fail to respond to first-line treatment despite remain depressed after 5 years (Keller et al., 1992). adequate dosage, duration and compliance (Klein Recurrence is common even in those who recover from an index episode: in a 10 year prospective study of recovery from an episode of major depres- sion, the median duration of individual recurrent * Corresponding author. episodes of illness was between 19 and 22 weeks 0165-0327 / 99 / $ – see front matter  1999 Elsevier Science B.V. All rights reserved. PII: S0165-0327(98)00201-8