When electroconvulsive therapy fails: Cognitive-behavioral therapy in treatment-resistant bipolar depression. A case report

Discussion: To date there is a lack of consensus on either the diagnostic criteria of TRBD or evidence-based guidelines for the treatment of TRBD. Adjunctive modafinil, pramipexole, tranylcypromine and vagus nerve stimulation have been tried but the response rate is variable. Family-focused treatment, group psychoeducation and interpersonal and social rhythm therapy have been tried in bipolar depression but more research is still required for TRBD patients that failed to respond to ECT. In conclusion, combination of CBT and pharmacotherapy is worth a try for TRBD patients who do not respond to ECT.