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Treatment-resistant depression complicates patient care and increases health care burden.3,8 Although there is no agreed-upon clinical definition for treatment-resistant depression, the working definition is an inadequate response to at least 2 antidepressant trials, with agents of differing classes of adequate dose and duration and treatment adherence.3 Table 1 describes in greater detail a system of staging treatment-resistant depression.9 The primary diagnosis of MDD should be confirmed in patients who appear to have treatment-resistant depression

In patients with chronic liver disease, independent of its genesis, especially in decompensated liver cirrhosis or a longer history of type 2 diabetes mellitus, monitoring of zinc levels should be instituted prior to the appearance of overt zinc deficiency symptoms, and zinc supplementation initiated when zinc levels in blood are reduced ( 45 mg elemental zinc have adverse effects on immune cells with inhibition of DNA synthesis and cytokine production [260]

Parsons, F

Recycling of BH2 by DHFR To break the cycle and re-couple eNOS, BH2 must be converted back into active BH4

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10.1073/pnas.2309317120 Proc