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Related Experiment Video

Updated: Jun 21, 2026

MRI-guided dmPFC-rTMS as a Treatment for Treatment-resistant Major Depressive Disorder
08:20

MRI-guided dmPFC-rTMS as a Treatment for Treatment-resistant Major Depressive Disorder

Published on: August 11, 2015

Treatment-resistant depression.

Alison Little1

  • 1Department of Family Medicine, Oregon Health and Science University, Portland, Oregon 97201, USA. littleal@ohsu.edu

American Family Physician
|July 23, 2009
PubMed
Summary
This summary is machine-generated.

Many patients with major unipolar depression do not respond to initial treatments. Cognitive behavior therapy shows similar effectiveness to medication for treatment-resistant depression, though sustained remission remains challenging.

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Area of Science:

  • Neuroscience
  • Psychiatry
  • Clinical Psychology

Background:

  • Major unipolar depression frequently exhibits resistance to initial pharmacologic treatments, affecting up to two-thirds of patients.
  • Treatment-resistant depression (TRD) is defined by inadequate response after at least two distinct antidepressant trials.
  • Limited evidence exists on the efficacy of psychotherapy for patients with TRD.

Purpose of the Study:

  • To evaluate the effectiveness of cognitive behavior therapy (CBT) as a treatment for major unipolar depression that is resistant to medication.
  • To compare CBT outcomes with alternative medication regimens in patients with treatment-resistant depression.

Main Methods:

  • A high-quality clinical trial assessed patients with depression unresponsive to citalopram.
  • Participants received either cognitive behavior therapy (with or without continued citalopram) or alternative medication regimens.
  • Response and remission rates were monitored throughout the study.

Main Results:

  • Patients receiving CBT (with or without citalopram) demonstrated response and remission rates comparable to those on other medication regimens.
  • Initial remission rates were 37%, with a cumulative remission rate of 67% after three additional treatment trials (medication or CBT).
  • Higher numbers of treatment steps correlated with increased relapse rates; sustained remission was achieved by less than half of patients.

Conclusions:

  • Cognitive behavior therapy presents a viable alternative to medication for treatment-resistant depression.
  • Achieving sustained remission in treatment-resistant depression remains a significant clinical challenge, with no single strategy proving superior.
  • Electroconvulsive therapy is effective for short-term TRD management, while vagal nerve stimulation lacks robust evidence for efficacy.