[Cognitive-behavioral therapy for treatment-resistant depression].

OBJECTIVE: To review the recent development of cognitive-behavioral therapy (CBT) for treatment-resistant depression (TRD).

METHODS: The recent literature on TRD was selected regarding the use of CBT, with both "classical" and "new generation" CBT being included. The Japanese algorithm for the treatment of TRD was revised to propose CBT as a first-step treatment option.

RESULTS: The efficacy of "classical" CBT for TRD varied across clinical trials: in one study CBT was comparable to pharmacotherapy when used in either augmentation or switch strategies; in another study, the combination of CBT and a switch to another antidepressant led to a more favorable clinical response than medication switch alone; and, in a third study, the concomitant administration of an atypical antipsychotic to CBT was found to be useful. One recent Japanese study showed positive acute and sustained effects on depressive symptoms and social functioning in TRD patients when group CBT was added to antidepressant medication. In recent years "new generation" CBT, such as the cognitive behavioral analysis system of psychotherapy (CBASP), dialectical behavioral therapy (DBT), and mindfulness-based cognitive therapy (MBCT), have been studied. A switch from antidepressant medication to CBASP was efficacious for non-responders to pharmacotherapy; participants in a DBT-based skills training group showed greater improvement in depressive symptoms compared with waiting-list controls; and, in two preliminary studies, MBCT was effective and acceptable for TRD patients.

CONCLUSIONS: CBT may be a promising option in the treatment of TRD. CBT could be a first-step treatment for all depressive disorders including TRD.