Psychotherapy effective for treatment-resistant depression in adults

Psychotherapy effective for treatment-resistant depression in adults

Brian McAvoy
Clinical question

How effective is psychotherapy for treatment-resistant depression (TRD) in adults?

Bottom line

There is moderate‐quality evidence that psychotherapy added to usual care (with antidepressants) is beneficial for depressive symptoms and for response and remission rates over the short term (6 months) for patients with TRD. Medium (7–12 months) and long‐term (>12 months) effects seem to be similarly beneficial, although most evidence was derived from a single large trial. Psychotherapy added to usual care seems to be as acceptable as usual care alone. Two studies noted similar beneficial effects after 12 months, and one study at 46 months. An economic analysis (conducted as part of an included study) from the UK healthcare perspective revealed adjunctive cognitive behavioural therapy is cost‐effective over nearly 4 years. Participants were aged between 18 and 74. Psychotherapies included CBT, interpersonal therapy, intensive short‐term dynamic psychotherapy and group dialectical behaviour therapy.


There is no direct evidence on the comparative effectiveness of different types of psychotherapies. There is no evidence on whether switching to a psychotherapy was more beneficial for this patient group than continuing an antidepressant medication regimen. Data for outcomes of quality of life, social functioning and resource use were limited.


Antidepressants are a first‐line treatment for adults with moderate-to-severe major depression. However, many people prescribed antidepressants for depression do not respond fully to such medication, and little evidence is available to inform the most appropriate “next step” treatment for such patients, who may be referred to as having TRD.

Cochrane Systematic Review

Ijaz S et al. Psychological therapies for treatment-resistant depression in adults. Cochrane Reviews, 2018, Issue 5. Art. No.: CD010558.DOI: 10.1002/14651858. CD010558.pub2. This review contains 6 studies involving 698 participants.