Both BAD and unipolar depression are common, serious and, in some cases, chronic conditions which often require long term pharmacotherapy. Drug side effects can be severe, contribute to poor compliance and are therefore a factor in maintaining illness and precipitating relapse. Treatment resistance is common. Current evidence suggests that a number of pharmacological agents which are available in other countries (and in some cases have been for many years) may be useful when side effects or treatment resistance occur. In some cases these alternatives are part of recommended algorithms for treatment. In New Zealand, when side effects occur, the options are limited and the problem of treatment resistance is usually approached by using poorly researched combinations of the currently available drugs, thus increasing the likelihood of side effects and adverse drug interactions. The current system is failing to provide appropriate or adequate treatment for people suffering from affective disorders and should be urgently reviewed.