Treatment-resistant mood and anxiety disorders require an intensive therapeutic approach, and it should balance benefits and adverse effects or other potential detrimental effects of medications. The goal of treatment is to provide consistent and lasting improvement in symptoms of depression and anxiety. Beozodiazepines are effective for anxiety symptoms, but with no sustained treatment effects. Other medication treatment options for anxiety disorders are outlined. Ketamine is usually very effective in treating maior depressive disorder but without sustained benefits. Loog-term use may pose a signiticant risk of developing tolerance and dependence. Stimulant medication augmentation for treatment-resistant depression is effective for residual symptoms of depression, but effects are usually short-lasting and it sounds mor as an artificial way of improving energy, alertness and cognitive functioning. Synthetic cannabinoids and medical marijuana are increasingly prescribed for various medical conditions. but more recently also for patients with mood and anxiety disorders. All of these treatments may raise ethical dilemmas about appropriateness of prescribing these medications and a number of questions regarding the optimal treatment for patients with treatment-resistant depression and treatment refractory anxiety disorders.

Background Treatment-resistant depression (TRD) is a significant problem in clinical practice and reason for the lack of functional recovery among depressed patients. Sleep disturbances and poor alertness are common residual symptoms. Main body of the abstract Many patients with refractory depression experience residual symptoms, such as insomnia, daytime sleepiness, and poor alertness. This is a literature review and we searched the electronic databases, including PubMed, the Cochrane database, Ovid MEDLINE, PsycINFO, and Google Scholar of all studies published between 2000 and 2020. The literature on the relationship between sleep quality and alertness in a patient with depression is very sparse. One possible reason could be the difficulty in defining alertness as a mental function. Alertness itself has been described as a state of responsivity to both interoceptive and external stimuli. Subjective and objective measures of alertness, daytime somnolence, and quality of sleep are presented. Adjunctive treatment with stimulant medications (methylphenidate, amphetamine, modafinil) to the standard antidepressant medications might be warranted in patients in patients with daytime sleepiness, decreased alertness, fatigue, and poor work performance. Short conclusion Patients with treatment-resistant depression usually suffer from poor quality of sleep and decreased alertness. Stimulant medications may help with alertness, daily functioning, and work performance.