FOCUS is truly intended to provide continuing medication education for practitioners that will have an impact on their practice by presenting state-of-the-art, evidence-based medicine. This issue of FOCUS is of particular relevance to psychiatrists because it provides an update on treatment-refractory psychiatric disorders including major depression, anxiety disorders, and schizophrenia. Many patients with psychiatric disorders are treated by nonpsychiatrists including family physicians, general practitioners, and obstetricians/gynecologists. This situation is unavoidable because there are simply too few psychiatrists to treat the large numbers of patients who have these major psychiatric illnesses. Therefore, as psychiatrists, we are referred the substantial numbers of patients with mood and anxiety disorders that do not respond to monotherapy with commonly prescribed psychopharmacological agents such as selective serotonin reuptake inhibitors.