CBT plus Medication is Effective for Treatment Resistant Depression

[David Baxter PhD]

CBT plus Medication is Effective for Treatment Resistant Depression
Cognitive Behavior Therapy News | Beck Institute Blog
December 19, 2012

According to a new study published online in The Lancet (December 7, 2012) and Contemporary Clinical Trials, cognitive behavior therapy (CBT) as an adjunct to usual care has shown to be an effective treatment for reducing depression and improving quality of life in patients with treatment resistant depression.

Although pharmacotherapy is often used as a first-line treatment for depression, only one-third of patients fully respond to anti-depressants and only half receive up to a fifty percent decrease in symptoms. The current study employed a large-scale CoBalT (two parallel-group) randomized controlled trial to investigate the effectiveness of combining CBT and usual care (including pharmacotherapy) versus usual care, alone, for treatment resistant depression. Participants (n=469) ranged from age 18 to 75 and were already taking anti-depressants. They were randomly assigned to receive either CBT plus usual care (n=234) or usual care alone (n=235).

At the 6 month follow up, 46% of participants (n=95) in the CBT plus usual care group met criteria for response to treatment, as compared to only 22% of participants (n=46) in the usual care group. Those who received CBT were more likely to experience remission, received lower scores on the Beck Depression Inventory (BDI), and experienced fewer symptoms of anxiety and panic. At the 12-month follow up, these improvements were maintained.

This study is the first large-scale randomized control trial investigating CBT treatment as an adjunct to usual care in patients showing treatment resistance to anti-depressants. Findings suggest that CBT in combination with usual care can be extremely effective for treating depressive symptoms and improving the quality of life of patients suffering from depression.

Source: Thomas, L. J., Abel, A., Ridgway, N., Peters, T., Kessler, D., Hollinghurst, S., Turner, K., … Wiles, N. (March 01, 2012). Cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment resistant depression in primary care: The CoBalT randomised controlled trial protocol. Contemporary Clinical Trials, 33, 2, 312-319.

 

[forgetmenot]

Did they do a study where just CBT was given with out medication and what results happen then.

 

[David Baxter PhD]

This really isn't anything new, other than perhaps its focus on CBT alone as the form of psychotherapy.

Studies over the years have repeatedly shown that appropriate medication plus appropriate psychotherapy is more effective - both in terms of speed of recovery and in terms of resistance to relapse - than either medication alone or psychotherapy alone.

I posted it here primarily as a reminder of how the term "Treatment Resistant Depression" is typically defined, i.e., as lack of response to medication rather than lack of response to treatment overall. I think sometimes health care practitioners, especially physicians, forget that medication is only part of an effective treatment strategy.

 

[forgetmenot]

I agree lack of response to medication is more likely then lack of response from therapy and yes the two together would obtain a better outcome if one was able to do them both for sure