Psychotherapy - or "talk therapy" -- is an effective treatment for depression. While it may not be enough on its own to resolve treatment-resistant depression, it can play an important role when used together with other treatments.

What Can Psychotherapy Offer?

Many studies have shown that therapy can be a powerful treatment for depression. Some, although not all, have found that combining depression medicine with therapy can be particularly effective. A 2004 review published in the Archives of General Psychiatry concluded that therapy combined with antidepressants worked better than depression medicine alone. It also found that therapy can help people stick with their drug treatment in the long term.

There are few conclusive studies of psychotherapy specifically in people with treatment-resistant depression, according to a review of treatments published in the Journal of Clinical Psychiatry in 2005. But many experts still recommend it. Therapy can help you:

Types of Psychotherapy Treatments

The first step is to find a qualified therapist -- usually a psychiatrist, psychologist, social worker, psychiatric nurse, or counselor. If possible, find someone who has expertise in helping people with treatment-resistant depression. Ask your health care provider for recommendations. Or get in touch with an organization like NAMI, The Nation's Alliance on Mental Illness, or the Depression and Bipolar Support Alliance (DBSA).

There are many different types of therapy. Here are some of the most common.

• Cognitive therapy, behavioral therapy, and cognitive behavioral therapy all focus on how your own thoughts and behaviors contribute to your depression. Your therapist will help you learn new ways to react to situations and challenge your preconceptions. You and your therapist might come up with concrete goals. You might also get 'homework' assignments, like keeping a journal, or applying problem-solving techniques in particular situations.
  
  
• Interpersonal therapy focuses on how your relationships with other people play a role in your depression. It focuses on practical issues. You will learn how to recognize unhealthy behaviors and change them.
  
  
• Psychodynamic therapy is a more traditional form of therapy. You and your therapist will explore the roots of your depression. You might focus especially on any traumas of your childhood.
  
  
• Group therapy gives you a chance to talk about your depression with other people who might have a similar condition. A therapist leads the group, which is what makes it different from a support group. The therapist might use any one or a combination of the approaches discussed above.

While there are many types of therapy, don't worry too much about the approach. Focus on finding a therapist whom you like and trust. Many therapists use a combination of approaches anyway.

While some people only need therapy for short periods of time, people with treatment-resistant depression might need it for longer. This is called maintenance therapy. Studies show that this lowers your risk of relapse. You and your therapist can watch for signs that your depression might be worsening. Over time, you will also learn about the patterns in your life that lead to depression.

Trying Psychotherapy Again

If you have treatment-resistant depression, you may have already tried psychotherapy. Maybe you didn't feel like it worked. But it may be time to give it a second chance. Here are some things to consider before you try again.

• Think about the reasons you didn't like therapy before. Why didn't it work? What did you need from therapy that you weren't getting?
  
  
• Decide what you want out of therapy now. Do you want to tackle specific problems? Do you want to work through upsetting events from your past? Come up with goals.
  
  
• Consider going back to your old therapist. Even if therapy didn't work last time, that doesn't mean that the therapist was at fault. The experience may be different if you approach therapy with specific goals this time. Going back to a previous therapist may be easier, since he or she will already know your history and situation.
  
  
• Consider trying someone new. It's very important that you like and respect your therapist. If you and your therapist didn't 'click,' therapy is unlikely to work. So you could try someone new. You might even want to meet with a few different therapists before choosing one. Ask about their approaches. Talk about your goals.
  
  
• Give it time. Once you have settled on a therapist, you need to give therapy a chance to work. Don't give up after a few sessions. Like depression medicine, therapy can take a little while before you feel the benefits.

SOURCES: American Psychiatric Association, Practice Guideline for the Treatment of Patients with Major Depression, 2000. American Psychological Association, Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision, American Psychiatric Association, 2000. Cadieux, R.J. "Practical Management of Treatment-Resistant Depression," American Family Physician, December 1998; vol 58: pp 2059-62. Compton M.T., "Depression and Bipolar Disorder," ACP Medicine, Psychiatry II, 2003. Depression and Bipolar Support Alliance web site, "Psychotherapy: How It Works and How It Can Help," "Treatment Challenges: Finding Your Way to Wellness." Fochtmann, L.J. and Gelenberg, A.J., Focus, Winter, 2005; vol 3: pp 34-42. Keller, M.B. Journal of Clinical Psychiatry, 2005; vol 66 (supp. 8): pp 5-12. Pampallona, S. Archives of General Psychiatry, 2004; vol 61: pp 714-719. Plakun, E. "A Psychodynamic Perspective on Treatment-Refractory Mood Disorders," Psychiatric Times, October 2002; vol 19. Stimmel, G. "Options for Treatment-resistant Depression," Psychiatric Times, July 2002; vol 19.