PEOPLE WITH DEPRESSION who have not responded to antidepressants are three times more likely to get better if they receive cognitive behavioural therapy (CBT) as well, scientists say.
This result was shown for the first time in a large-scale randomised trial, with scientists demonstrating that people with depression who have not responded to treatment with antidepressants are three times more likely to get better if they receive CBT in addition to antidepressants and usual care.
The findings were published in The Lancet, which notes that two-thirds of people with depression do not respond fully to initial treatment with an antidepressant.
Nicola Wiles from the University of Bristol, who led the research, said:
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.
Trial
In total, 469 adults (aged 18–75 years) took part in the trial. They had not responded to at least six weeks of treatment with an antidepressant.
They 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). Their progress was followed up for 12 months.
After 6 months, 46 per cent of participants who received CBT in addition to usual care had improved, and reported at least a 50 per cent reduction in depressive symptoms, compared to 22 per cent 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.
However, Wiles noted that: “In many countries access to CBT is limited to those who can afford it. Even in the UK where there has been substantial investment in psychological services, many people who have not responded to antidepressants still do not receive more intensive psychological therapies such as CBT that take 12 to 18 sessions.”
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