The objective of this study was to increase recognition of ultra-rapid metabolising status as a cause of treatment-resistant depression and consider management options.

The incidence of ultra-rapid metabolising status is not rare in patients who fail to report improvement with antidepressant medication. Two broad options are available for identifying ultra-metabolising status. While there are several management options available to the clinician, combination therapy is likely of low utility while there are risks associated with mega-prescribing. As the literature is limited, clinician observations about alternate strategies would be welcomed.