["Journal of Clinical Psychology, EarlyView. ", "\nABSTRACT\n\nObjectives\nThis study investigates the adjunctive effects of mindfulness‐based cognitive therapy (MBCT) combined with escitalopram hydrobromide on cognitive function and emotional well‐being in older adults with treatment‐resistant depression (TRD). We hypothesized that this combined approach would lead to greater enhancements in cognitive abilities and overall well‐being compared to escitalopram hydrobromide alone in this vulnerable population.\n\n\nMethods\nA total of 230 older adults with TRD and cognitive impairment were randomly assigned into two groups: an experimental group receiving MBCT plus escitalopram (n = 115) and a control group receiving escitalopram alone (n = 115). Cognitive function, depression severity, and quality of life were assessed at baseline, 6 weeks, and 12 weeks using the Montreal Cognitive Assessment (MoCA), Hamilton Depression Rating Scale (HAM‐D), and General Quality of Life Index‐74 (GQOLI‐74).\n\n\nResults\nThe experimental group demonstrated significant improvements in cognitive function (MoCA scores) and quality of life (GQOLI‐74 scores) compared to the control group at both 6 and 12 weeks (p < 0.05). Additionally, depression severity (HAM‐D scores) was significantly reduced in the experimental group (p < 0.05). The combined therapy also resulted in higher rates of significant and effective treatment outcomes, with fewer cases of average or ineffective responses (p < 0.05).\n\n\nConclusions\nThe integration of MBCT with escitalopram hydrobromide significantly enhances cognitive function, reduces depressive symptoms, and improves quality of life in older adults with TRD.\n\n\nClinical Implications\nClinicians should consider incorporating mindfulness‐based interventions alongside pharmacological treatments for older adults with TRD.\n\n\nTrial Registration\nThe trial was retrospectively registered with ClinicalTrials. gov (Identifier: NCT07077291).\n"]