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CBT effective treatment for depression

Study shows patients 3-times more likely to improve with CBT

Jo Carlowe

Friday, 07 December 2012

Depressed patients who have not responded to antidepressants are more likely to get better if they receive cognitive behavioural therapy (CBT).

For the first time in a large-scale randomised trial, scientists have demonstrated that people who have not responded to drug treatment, are three times more likely to get better if they receive CBT in addition to antidepressants.

The findings, published Online First in The Lancet are good news for the two-thirds of people with depression who do not respond fully to initial treatment with an antidepressant.

“Until now, there was little evidence to help clinicians choose the best next step treatment for those patients whose symptoms do not respond to standard drug treatments,” says Nicola Wiles from the University of Bristol who led the research.

Wiles and colleagues recruited 469 adults (aged 18–75 years) who had not responded to at least 6 weeks of treatment with an antidepressant from 73 general practices across the UK. Participants were randomised to either continue with usual care provided by their general practitioner, which included continuing on antidepressant medication (235 patients), or to receive CBT in addition to usual care (234 patients) and were followed up for 12 months.

After 6 months, 46% of participants who received CBT in addition to usual care had improved (reporting at least a 50% reduction in depressive symptoms) compared to 22% of those who continued with treatment as usual. Individuals in the intervention group were also more likely to experience remission and have fewer symptoms of anxiety. Similar beneficial effects were reported at 12 months.

Writing in a linked Comment, Michael Otto from Boston University, USA, and Stephen Wisniewski from the University of Pittsburgh, USA, note that the timing of this study is particularly fortuitous because of the £500 million that the UK Government has recently allocated to the Improving Access To Psychological Therapies (IAPT) scheme to increase access to treatments such as CBT for depression. They state the findings “add to the already impressive efficacy for CBT as assessed for other stages of treatment …If the broader IAPT vision is realised, it has the potential to serve as a model for depression treatment for other nations.”

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