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Nonpharmacologic Interventions for Treatment-Resistant Depression in Adults

Systematic Review Archived

Archived: This report is greater than 3 years old. Findings may be used for research purposes, but should not be considered current.

 

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Review

This review from the RTI International–University of North Carolina at Chapel Hill Evidence-based Practice Center (EPC) provides a comprehensive summary of the available data addressing the comparative effectiveness of four nonpharmacologic treatments as therapies for patients with treatment-resistant depression (TRD): electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), vagus nerve stimulation (VNS), and cognitive behavioral therapy or interpersonal psychotherapy (CBT or IPT).

The core patient population of interest was patients with major depressive disorder (MDD) who met our definition of TRD: failure to respond following two or more adequate antidepressant treatments. We also included TRD studies in which the patient population could include a "mix" of up to 20 percent of patients with bipolar disorder (i.e., 80 percent or more of patients had only MDD), assuming that this small mix would not substantially alter outcomes seen with MDD-only populations.