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<p>Abstract</p> <p>The purpose of this case study was to use an evidence based medicine approach to work through an unusual way of treating a common problem. We looked at an example of an in-patient with severe refractory psychotic depression who had been resistant to treatment with a combination of antidepressant, antipsychotics, mood stabiliser, and concomitant ECT therapy.</p> <p>We then undertook a literature search for the use of clozapine in a patient with severe refractory depression.</p> <p>Although the resulting evidence was low level and thin, we felt on balance that a trial of clozapine was justified.</p> <p>We used a BPRS inventory to monitor her mood prior to commencing clozapine. Her mood and functional abilities were monitored as her clozapine was titrated upwards.</p> <p>Our patient showed a significant improvement in mood and functional abilities and a reduction in her BPRS score during this period. Her symptoms improved to the point where she was successfully discharged home on a combination of clozapine and an antidepressant.</p> <p>The improvement was sustained for a further two years.</p> <p>We thought this was an important case to highlight the limited evidence in using this successful form of treatment for a common clinical problem and that further research in this area was needed.</p>