Dr Nicola Wiles, from the School of Social and Community Medicine at the University of Bristol said: ‘Antidepressants are often prescribed for people with depression, but we know that many people don’t fully respond to such treatment. CBT, a type of talking therapy, is a way of helping people with depression change the way they think in order to improve how they feel, and to change what they do. It’s an educational approach, in which the patient learns skills to help them better manage their mood. We previously found that CBT was an effective treatment reducing depressive symptoms and improving quality of life over 12 months for patients who hadn’t responded to antidepressants, but before this study, there was very little evidence about the effectiveness of CBT over the long term.’
The study found when CBT was given, in addition to usual care that included antidepressants, it was effective in reducing depressive symptoms and improving quality of life over the long term – on average 46 months – for patients whose depression had not responded to medication. These benefits were found, on average, 40 months after the end of therapy.
Over the course of 46 months, 43 per cent of those who had received CBT had improved, reporting at least a 50 per cent reduction in symptoms of depression, compared with 27 per cent who continued with their usual care alone. Importantly, the study also found that this type of ‘high intensity’ CBT was a cost effective treatment from the perspective of the health service.
Dr Wiles said: ‘Our results show the importance of investment in psychological services. While there have been initiatives to increase access to such treatments in both England and Australia, these have mainly focussed on increasing ‘low intensity’ programmes, such as computerised CBT packages and guided self-help, for which there is little evidence of long-term effectiveness. Our study suggests that by investing in ‘high intensity’ CBT as delivered in the CoBalT trial, it is possible to reduce the significant burden to patients and healthcare systems that is associated with non-response to the most common treatment for depression.’
The research was conducted by academics at the University of Bristol, along with colleagues from the Universities of Exeter, Oxford, Glasgow, and University College London. Their paper, ‘Long-term effectiveness and cost-effectiveness of cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment resistant depression in primary care: follow-up of the CoBalT trial’ was published on January 6 in The Lancet Psychiatry. The research was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA).
‘Long-term effectiveness and cost-effectiveness of cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment resistant depression in primary care: follow-up of the CoBalT trial’ by Nicola J Wiles et al in The Lancet Psychiatry.
University of Bristol