According to a commentary, it is striking that the current evidence base about the efficacy of treatment in depression, even in treatment-resistant depression, has largely excluded those with very chronic and severe depression who are treated in NHS secondary-care settings. It commends the researchers for investigating improved management for people with severe depression in secondary care, but expresses disappointment at the trial findings, noting that on their own, they cannot justify the development of specialist teams. It highlights the need to develop new treatments, evaluate new approaches, and investigate older treatments in severe depression and other non-psychotic disorders in secondary care. It concludes “a dearth of research exists for a relatively common problem in psychiatric services and patients are being provided with little more than guesswork supplemented with well-intentioned common sense.”