Electroconvulsive therapy (ECT) is an effective treatment for major depressive disorders. Medication resistance and persistent depression is encouraged by modern research practice. Before a depressed patient is labeled 'medication-resistant', the presence of delusions must be carefully assessed. A delusional mood disorder warrants intensive therapy, either with the combination of a neuroleptic and a tricyclic antidepressant drugs (TCA), both in high doses, or a course of ECT. The recognition of a major depressive mood disorder in an adolescent is difficult, and few studies find medications effective. It is now fashionable to develop clinical practice guidelines for the treatment of systemic disorders. A greater acceptance of ECT as an effective and safe treatment and its reasonable consideration before less effective treatments are tried will do much to relieve the burdens of therapy resistance of the severe mentally ill, for themselves, for their families, and for society.