This paper published in a mainstream psychiatric journal was accompanied by an editorial. Among the authors you will see Robert K. Naviaux. You may recognize others. About 15% of cases of clinical depression are categorized as "treatment-resistant" or "treatment-refractory". Depression is called the "common cold" of psychiatry, so this is not particularly rare. Patients included in this study had attempted suicide. Among long-term "treatment-refractory" cases actual completed suicide may reach 50%. Many others are permanently disabled. These authors found a surprising percentage of metabolic disorders in the research cohort, and a number of patients responded well to metabolic interventions based on the particular abnormality discovered. None of the healthy controls showed such abnormalities. This is a small study, but the striking nature of the results, in cases where other approaches had been exhausted, suggests reconsideration of diagnostic techniques used in psychiatry. The implication is that significant numbers of patients diagnosed with a life-threatening psychiatric condition actually have treatable primary metabolic problems.