Treatment-resistant depression (TRD) patients do not respond to antidepressant medication and have a chronic and debilitating form of major depressive disorder (MDD). TRD patients may benefit from trauma-focused psychotherapies, specifically trauma-focused cognitive behavioral therapy (TF-CBT) and eye movement desensitization and reprocessing therapy (EMDR). These psychotherapies significantly reduced depressive symptoms, with EMDR’s effects, in particular, being maintained at 12 weeks follow-up.
MDD is an extremely disabling disorder that is difficult to treat and often accompanied by impairments in well-being and function. A substantial percentage of MDD patients (15-30%) do not respond to one or more antidepressant treatment, which is classified as having treatment-resistant depression (TRD). There is much evidence that childhood trauma, or life stress events, is indirectly or directly associated with TRD. Thus, trauma-focused treatments may be effective in treating TRD. Trauma-focused therapies such as TF-CBT and EMDR are known evidence-based treatments for childhood and adult PTSD. There is new evidence suggesting these treatments being effective for other disorders such as bipolar disorder and MDD. No prior studies have investigated the application of EMDR and TF-CBT to TRD.
Materials and methods
Twenty-seven TRD patients received either TF-CBT or EMDR in addition to pharmacological treatment. Treatments were conducted 3 times a week for 8 weeks (total of 24 sessions). Assessments for depressive symptoms were carried out at baseline (T0), at four weeks of treatment (T4), after 8 weeks of treatment (T8), and four weeks after the end of treatment (T12). A phone interview was conducted for clinical assessment 24 weeks after the start of treatment (T24).
The trauma-focused psychotherapies reduced depressive symptoms, with significant differences between EMDR and TF-CBT. EMDR had a higher efficacy (measured as lower MADRS scores) than TF-CBT at follow-up (T12). The treatments also improved anxiety symptoms, disturbances in sleep, and impairments in social functioning.
This is the first study exploring the efficacy of trauma-focused therapies on treating TRD. Both EMDR and TF-CBT were effective, with EMDR having more immediate depressive symptom relief that was maintained longer. The relationship between childhood traumatic experiences (i.e., childhood abuse) and MDD, particularly more severe and complex depression, is well studied. Childhood trauma also poses a major risk factor for complex MDD symptomatology that responds poorly to pharmacological treatments. There is a high co-occurrence of MDD and TRD with PTSD, making trauma-focused treatments (and their efficacy) all the more important.