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17-12-2012 | General practice | Article

CBT boosts depression response


Lancet 2012; Advance online publication

medwireNews: Patients with depression who do not respond to initial pharmacological treatment can benefit from adjunctive cognitive behavioural therapy (CBT), report UK researchers.

Their randomised study included 469 patients who had not responded to treatment with an antidepressant for at least 6 weeks; patients assigned to CBT on top of usual care were three times more likely to respond to treatment than those assigned to usual care only.

Response was defined as a 50% reduction in depressive symptoms as measured on the Beck Depression Inventory (BDI) - 95 (46%) patients in the intervention group achieved this by 6 months, compared with 46 (22%) in the usual care group.

The intervention involved 12 sessions of individual CBT, with up to a further six sessions if deemed clinically appropriate by the therapist. Participants assigned to usual care could be referred for counselling, CBT, or to secondary care if clinically appropriate.

Dr Nicola Wiles (University of Bristol) and colleagues report that the benefit of CBT was also seen at 6 months for the more stringent outcome of remission, defined as achieving a BDI score of less than 10.

Furthermore, both these improvements were maintained over 12 months.

"A substantial proportion of people do not respond to antidepressants and our results have provided robust evidence that CBT given as an adjunct to usual care that includes antidepressant medication is an effective treatment in reducing depressive symptoms and improving quality of life in this population," the authors write in The Lancet.

Drs Michael Otto (Boston University, Massachusetts, USA) and Stephen Wisniewski (University of Pittsburgh, Pennsylvania, USA) comment in a related editorial that the findings are promising and add to the "already impressive" evidence for the efficacy of CBT as a first-line alternative to pharmacological treatment, and as a strategy for discontinuing antidepressants.

medwireNews is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

By Caroline Price, Senior medwireNews Reporter