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Abstract
We have investigated the choice of treatment for depressed patients who do not respond to a therapeutic trial of fluoxetine, across three age groups. A postal questionnaire and a case vignette of a depressive patient was sent to 500 consultant psychiatrists. The vignettes were identical in all cases, except that the age was given as either 20, 30 or 70 at random. The respondents were asked to choose their next management option for the case they were sent. Fifty-eight per cent of questionnaires were returned complete. Changing fluoxetine to a different antidepressant was the most popular choice across all three age groups. Lithium augmentation was the least popular physical treatment option. Significantly more respondents who were sent the 70-year-old case chose ECT. This result was not related to the respondents' subspeciality. These findings are discussed in relation to available research evidence concerning the treatment of patients resistant to standard doses of fluoxetine.