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.''