Use of Psychotherapy in Treatment-Resistant Depression

摘要

Treatment-resistant depression (TRD) is a difficult disease to treat, and single interventions, such as pharmacologic treatment, are often inadequate. Treatment resistance can occur in up to 20% of patients with depression, but psychotherapy can help in managing symptoms and achieving remission status. Psychotherapy can help target depressive symptoms, as well as comorbid symptomatology that exacerbates or triggers depression, such as anxiety, personality disorders/traits, and medical issues. The most-studied therapeutic interventions are cognitive-behavioral therapies, but evidence exists for Acceptance and Commitment Treatment, Cognitive Behavioral Analysis System of Psychotherapy, Dialectical Behavioral Therapy, and Mindfulness-Based Cognitive Therapy in the treatment of TRD, and there are some promising data for psychodynamic therapies as well. Obstacles to implementing psychotherapy in patients with TRD pertain mostly to access, although they also relate to lack of training in manualized therapies and financial/cost challenges. Clinicians are encouraged to incorporate psychotherapy in TRD treatment as early as possible to avoid worsening symptom chronicity.