Depression is a very common illness which has a major impact on a patient’s life. In the UK between five and ten per cent of the population has the illness at any one time. Globally the World Health Organisation estimates around 350 million people suffer from the illness.
The most commonly used treatment for depression is antidepressants, and although drug treatments can be effective, up to two thirds of patients don’t respond fully to them.
Another treatment is CBT, a form of talking therapy, that helps patients change their thinking and behaviour in response to their thoughts.
Researchers from the CoBalT study group – a collaboration between the Universities of Glasgow, Bristol and Exeter – followed 469 patients aged 18- to 75-years with treatment-resistant depression in a randomised controlled trial.
Patients were split into two groups. 235 patients continued with their usual care from their GP, which included continuing on antidepressant medication. And 234 patients were treated with CBT in addition to their usual GP.
Researchers followed-up 422 patients (90 per cent) at six months and 396 (84 per cent) at 12 months to compare their progress.
At six months, 46 per cent of those who received CBT in addition to usual care had improved, reporting at least a 50 per cent reduction in symptoms of depression, compared to 22 per cent of those who continued with usual care alone. This beneficial effect was maintained over 12 months.
The findings demonstrate that CBT provided in addition to usual care including antidepressant medication is an effective treatment that reduces depressive symptoms, and improves the quality of life in patients whose depression has not responded to the most common first-line treatment for depression in primary care.
Chris Williams, Professor of Psychosocial Psychiatry at the University of Glasgow, said: “This research is of great importance because it used a CBT intervention alongside treatment with antidepressants.
“It confirms how these approaches – the psychological and physical – can complement each other. It was also encouraging because we found the approach worked to good effect across a wide range of people of different ages and living in a variety of settings.”
Dr Nicola Wiles, the study’s lead author and a Senior Lecturer in the University of Bristol’s School of Social and Community Medicine, added: “These findings emphasise the importance of increasing the availability of psychological therapy. While there have been initiatives to increase access to such treatments in both the UK and Australia, worldwide initiatives are rare, and even in the UK many people who have not responded to antidepressants do not get psychological treatment.
“Our study suggests that by investing in psychological services it is possible to reduce the significant burden to patients and healthcare systems that is associated with non-response to antidepressant medication.
“Furthermore, it is important to acknowledge that while we found that CBT was an effective treatment for this patient group, not everyone who received CBT improved.
“It is therefore essential that we invest in further research in this area to investigate alternative treatment options, both pharmacological and non-pharmacological, for the significant number of patients whose depression does not get better following treatment with antidepressants.”
The research was funded by the National Institute for Health Research(NIHR) Health Technology Assessment (HTA) programme. And the findings were published in The Lancet medical journal entitled: “Cognitive behavioural therapy as an adjunct to pharmacotherapy for primary care based patients with treatment resistant depression: results of the CoBalT randomised controlled trial”.
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