Giguère Sabrina, Fortier Alexandra, Azrak Julie, Giguère Charles-Édouard, Potvin Stéphane, Dumais Alexandre
Department of Psychiatry and Addictology, University of Montreal, Montreal, QC H3T 1J4, Canada.
Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada.
J Pers Med. 2025 Aug 1;15(8):338. doi: 10.3390/jpm15080338.
Depression that is resistant to two or more adequate treatment trials-treatment-resistant depression (TRD)-is a prevalent clinical challenge. Although psychotherapies have been recommended by clinical guidelines as an alternative or adjunctive treatment strategy, the effectiveness of psychotherapy in individuals with TRD has not yet been evaluated through meta-analytic methods, primarily due to a limited number of trials. This highlights the necessity of personalized research targeting this specific population. This systematic review and meta-analysis aimed to summarize the evidence on psychotherapy in treating TRD. A systematic search was conducted following the Guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Articles were included if they quantitatively examined the efficacy of psychotherapy on depression symptoms in individuals diagnosed with depression who had not responded to at least two prior treatments (i.e., pharmacotherapy and/or psychotherapy). A total of 12 studies were included. The quality of evidence was evaluated as being globally moderate. When pooling all psychotherapies, a small-to-moderate, but significant, effect on depressive symptoms was observed compared to the control group (SMD = -0.49, CI = -0.63; -0.34). The observed effect remained unchanged after removing the outlier (SMD = -0.47, CI = -0.62; -0.32). When examining depressive symptoms by type of psychotherapy, Mindfulness-Based Cognitive Therapy (SMD = -0.51, CI = -0.76; -0.25), Cognitive Behavioral Therapy (SMD = -0.53, CI = -0.92; -0.14), and Cognitive Therapy (SMD = -0.51, CI = -1.01; -0.01) showed a moderately significant effect on depressive symptoms compared to the control group. Although this potentially represents the first meta-analysis in this area, the number of studies specifically addressing this complex population remains limited, and the existing literature is still in its early stages. Research focusing on TRD is notably sparse compared to the broader body of work on depression without treatment resistance. Consequently, it was not possible to conduct meta-analyses by type of psychotherapy across all treatment modalities and by type of control group. Due to several study limitations, there is currently limited evidence available about the effectiveness of psychotherapy for TRD, and further trials are needed. Beyond the treatments usually offered for depression, it is possible that TRD requires a personalized medicine approach.
对两种或更多充分治疗试验均无反应的抑郁症——难治性抑郁症（TRD）——是一个普遍存在的临床挑战。尽管临床指南已推荐心理治疗作为一种替代或辅助治疗策略，但心理治疗对TRD患者的有效性尚未通过荟萃分析方法进行评估，主要原因是试验数量有限。这凸显了针对这一特定人群进行个性化研究的必要性。本系统评价和荟萃分析旨在总结心理治疗TRD的证据。按照系统评价和荟萃分析的首选报告项目指南（PRISMA）进行了系统检索。如果文章定量研究了心理治疗对至少对两种先前治疗（即药物治疗和/或心理治疗）无反应的抑郁症患者抑郁症状的疗效，则纳入这些文章。共纳入12项研究。证据质量整体评估为中等。汇总所有心理治疗方法时，与对照组相比，观察到对抑郁症状有小到中等但显著的效果（标准化均数差[SMD]= -0.49，可信区间[CI]= -0.63；-0.34）。剔除异常值后，观察到的效果保持不变（SMD = -0.47，CI = -0.62；-0.32）。按心理治疗类型检查抑郁症状时，基于正念的认知疗法（SMD = -0.51，CI = -0.76；-0.25）、认知行为疗法（SMD = -0.53，CI = -0.92；-0.14）和认知疗法（SMD = -0.51，CI = -1.01；-0.01）与对照组相比，对抑郁症状显示出中度显著效果。尽管这可能是该领域的首次荟萃分析，但专门针对这一复杂人群的研究数量仍然有限，现有文献仍处于早期阶段。与关于无治疗抵抗的抑郁症的更广泛研究相比，关注TRD的研究明显较少。因此，无法按心理治疗类型、所有治疗方式和对照组类型进行荟萃分析。由于多项研究局限性，目前关于心理治疗对TRD有效性的证据有限，需要进一步试验。除了通常用于治疗抑郁症的方法外，TRD可能需要个性化医疗方法。
