This document discusses treatment-resistant depression and provides strategies for managing it. Treatment-resistant depression is defined as failing to respond to adequate trials of two antidepressants or one antidepressant and electroconvulsive therapy (ECT). Left untreated, it can lead to reduced quality of life, relationship and economic problems, increased physical health issues, and even suicide. Effective management of treatment-resistant depression involves thoroughly reviewing the diagnosis and treatment history, ensuring medication compliance, continuing or changing antidepressant medications, adding augmentative therapies like mood stabilizers or ECT, and considering psychosurgery in severe cases.