UK Researchers Discover the Power of CBT for Persistent Depression | Print |  E-mail
Monday, 04 March 2013

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Researchers from the School of Social and Community Medicine at the University of Bristol in the UK evaluated the effectiveness of CBT (Cognitive Behavioral Therapy) as an adjunct to pharmacotherapy for patients with treatment-resistant depression, as compared to usual care.

This two parallel-group, multicenter, randomized, controlled trial recruited 469 patients with treatment resistant depression, between the ages of 18-75 years, from 73 primary care practices.  (The criteria being that they were on antidepressants for at least ≥6 weeks, scored ≥14 on the Beck Depression Inventory [BDI] and scored -10 on depression on the ICD International Classification of Diseases.)

Participants were randomized, with a computer generated code to one of two groups: usual care or CBT in addition to usual care. They were followed for 12 months. Analyses were by intention to treat. The primary outcome was response, defined as at least 50% reduction in depressive symptoms (BDI score) at 6 months compared with baseline.

Between Nov 4, 2008, and Sept 30, 2010,  235 patients were assigned to usual care, and 234 to CBT plus usual care.  There were 422 participants (90%) who were followed up at 6 months, and 396 (84%) at 12 months. Ninety-five participants (46%) in the intervention group met the criteria for response at 6 months, as compared with 46 (22%) in the usual care group (odds ratio 326, 95% CI 210-506, p<0001).

Before this study, there was no evidence available from large-scale randomized controlled trials for the effectiveness of augmenting antidepressant medication with CBT as a next-step for patients whose depression does not respond to pharmacotherapy.  This study has provides robust evidence that CBT as an adjunct to usual care is an effective treatment, reducing depressive symptoms in this population.

Citation:  Wiles N, Thomas L, Abel A, Ridgway N, Turner N, Campbell J, Garland A, Hollinghurst S, Jerrom B, Kessler D, Kuyken W, Morrison J, Turner K, Williams C, Peters T, Lewis G. Cognitive behavioural therapy as an adjunct to pharmacotherapy for primary care based patients with treatment resistant depression: results of the CoBalT randomised controlled trial. Lancet. 2013 Feb 2;381(9864):375-84. doi: 10.1016/S0140-6736(12)61552-9. Epub 2012 Dec 7.

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written by Marty Slager, March 07, 2013
A note of thanks to you, Bellaruth! Treatment resistant depression...CBT...years on anti-depressants...yes, I know all about that. I am "Ann Marie" of the "Weight Loss" CD. (I love that name you gave me - kind of my new identity.) Misdiagnosed as bi-polar, I had lost hope of ever emerging from the tangled web of depression, and went to a new therapist looking simply for some kind of semi-effective pain management. Through several years of skilled and careful EMDR, the journey out of the "night-time amnesia" began. All facts have since been verified by my family and others. It is all really true, as devastating as that was to accept.
But I had no idea the journey out of years and years of incest and then marital abuse would be this long, rocky and painful. Many times I would have ended my pain in death. But I feel like you, Bellaruth, and your staff are walking along with me with your Guided Imagery. I listen often to "Healing Trauma" - I love the beauty and brightness as we go down the tunnel. I love the images of light/breeze/mist in "General Wellness," and the hopefulness embedded in "Overcoming Depression." But it's the "Weight Loss" can-do-total-confidence in both progress made and letting go of old baggage along with the wonderful image of emptying out the closets of old ideas and self-judgements that has kept me alive and refusing to give up.
And you're always there, available any hour of the night or day. (The "Panic Attack" CD has been literally a God-send!) If my wonderful therapist has to cancel, or is booked solid, you are there, and you always seem to "get it." Like you say, different comments come alive at different times, touching my deepest need in the moment. CBT was useful, but only in a very limited way because it couldn't touch the base of the issue - imbedded deep in my heart and psyche.
So, I send this note of thanks. Thank-you for your work and research, for delaying retirement, for your wonderfully helpful weekly updates. I don't feel so alone and battered any more.

Blessings to you all,
"Ann Marie"

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