Harvard Mental Health Letter

Options for treatment-resistant depression

Why electroconvulsive therapy may be the best alternative to medication.

 Although medications and psychotherapy are usually the first treatments offered to patients with major depression, they don't work for everyone. As we reported in August 2008, the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study found that about one-third of patients were unable to achieve full relief of symptoms (remission) even after trying four different strategies.

But the STAR*D data on relapse rates suggest that treatment-resistant depression may be even more common than remission rates might indicate. Relapse was a significant problem at each treatment level. By the end of the study, 50% of the patients who were able to achieve remission after trying a fourth treatment ended up relapsing within an average of 2.5 months.

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