Treatment-resistant depression has become a growing public health problem due to high relapse, hospitalization, and mortality rates, along with diminished quality of life. A review of literature up to May 2022 on PubMed, PsychInfo, and Cochrane Library examined advances in recognizing and treating this condition. Patients who do not respond to antidepressants require additional pharmacological and instrumental therapies. Recently, esketamine and psilocybin have drawn particular clinical interest, alongside instrumental treatments such as vagus nerve stimulation, deep brain stimulation, repetitive transcranial magnetic stimulation, transcranial direct current stimulation, epidural cortical stimulation, and electroconvulsive therapy. Future research should establish valid criteria and provide reliable data on benefits, risks, and costs of these therapies.
Dreams originate through multiple brain mechanisms, not a single generator. Frontoparietal regions support dream recall, consistent with the Global Workspace theory of consciousness, but dreams in different sleep stages show distinct features, implying several generators. Blind individuals, including those congenitally blind, can still produce visual dreams, suggesting bottom-up mechanisms linked to innate body schemes or multisensory integration. A new dream-engineering technique may clarify multisensory integration during sleep and offer rehabilitation possibilities for sensory-impaired people. The Theory of Proto-consciousness proposes that waking and dreaming brain states interact for optimal functioning, potentially making dreaming a rehabilitative tool.