Cognitive-behavioral management of drug-resistant major depressive disorder

BACKGROUND The application of cognitive-behavioral treatment to drug-resistant major depression has received little research attention. METHOD Nineteen patients who failed to respond to at least two trials of antidepressant drugs of adequate dosages and duration were treated by cognitive-behavioral methods in an open trial. RESULTS Three patients dropped out of treatment. The remaining 16 patients displayed a significant (p < .001) decrease in scores on the Clinical Interview for Depression after therapy. Twelve patients were judged to be in remission at the end of the trial; only 1 of these patients was found to have relapsed at a 2-year follow-up. Antidepressant drugs were discontinued in 8 of the 12 patients who responded to cognitive-behavioral treatment. CONCLUSION These preliminary results suggest that a trial of cognitive-behavioral therapy by an experienced therapist should be performed before labeling an episode of major depression as "refractory" or "treatment resistant." These latter terms should apply only when a psychotherapeutic effort has been made. Until then, it seems more appropriate to define depression as "drug refractory" or "drug treatment resistant."