Management of treatment-resistant depression: Psychotherapeutic perspectives

Treatment-resistant depression is a heterogeneous condition that occurs wit hin a psychosocial milieu. The impact of prior pharmacologic interventions may have been adversely affected by a poor therapeutic alliance, low social support, life stress, or chronic adversity and cognitive or personality fa ctors such as neuroticism or pessimism. This article considers the psychoso cial factors that predispose to treatment-resistant depression and the psyc hotherapeutic principles thought to be helpful in both shorter- and longer- term treatment plans. We focus on the interpersonal, cognitive, and behavio ral forms of treatment that constitute the depression-focused psychotherapi es, which have been studied in major depressive disorder. Also discussed ar e modifications in treatment planning necessary to take into account the co mplexity of treatment-resistant depression.