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Evidence at a glance on talking therapies for depression

Three recent NIHR studies have provided useful new evidence on particular aspects of talking therapies for depression. This Highlight considers some of the key points arising from the studies, but it is not a complete review of all the evidence in this area (see About the research for more information).

What does this new evidence tell us about when, and for whom, cognitive therapies may be effective?

Computerised cognitive behavioural therapy

  • Two types of computerised cognitive behavioural therapy (CBT), delivered in primary care, did not appear to be more effective than usual care alone in reducing depression.
  • This form of CBT was accessed by patients on computers at home, with the offer of regular technical support by telephone but no direct contact with a therapist. Most patients did not complete the course.
  • There is some existing evidence from small-scale studies that computerised CBT might be more effective if accompanied by support from trained practitioners. The NIHR has funded a study to explore this further.

Combining CBT and anti-depressants

  • Face to face CBT, used in conjunction with anti-depressant medication, appeared to be effective for people whose depression had not responded to medication alone.
  • Patients who received both CBT and anti-depressants were more likely to have improved depressive symptoms and better quality of life, up to four years later, compared to people who just took anti-depressants.

Mindfulness-based cognitive therapy

  • Mindfulness-based cognitive therapy (MBCT) may provide an alternative for people with recurrent depression, especially those who have difficulty in adhering to maintenance anti-depressant medication.
  • Patients who participated in MBCT, instead of anti-depressants, had similar relapse rates to those who continued with anti-depressants alone.
  • There are some early indications that MBCT may be particularly effective for people who have experienced severe childhood abuse, and whose depression may therefore be especially difficult to treat. This area requires more research.

Does the research tell us anything about cost-effectiveness?

  • CBT and anti-depressants together were likely to be cost-effective for people with depression who have not responded to anti-depressants alone.
  • MBCT was no more cost-effective than anti-depressants. However, costs were similar for patients receiving MBCT and those receiving anti-depressants, as were outcomes, so from a cost perspective MBCT may be a reasonable alternative.

What do patients think about these types of cognitive therapy?

  • Interviews with participants in some of the studies suggest that many people find cognitive therapies useful, and in some cases were glad to have an alternative to anti-depressants.
  • Patients had mixed feelings about computerised CBT accessed at home without contact with a therapist. It was convenient for some but others found it hard to maintain their motivation (which is a particular problem for people with depression).
  • Both MBCT and CBT are intensive processes requiring significant commitment of time and effort. This will not suit everyone, and interviews with study participants suggest that those with other health conditions found it particularly difficult. MBCT is typically delivered in a group setting which, again, may not suit everyone.
  • There is currently no clear evidence about which patients might be more or less likely to benefit from cognitive therapies, so all patients should be considered for these therapies. It is important that patients know about all the different treatment options and what they involve before making a decision.

 Key questions for GPs and other healthcare professionals

  • Are you aware of the range of cognitive therapies on offer in your area for patients with depression?
  • How many of your patients with depression have been offered some sort of talking therapy? Does this include patients for whom anti-depressants have not been effective?
  • Are patients able to access a range of options (such as group, individual, face to face, online therapies), according to the stage and severity of their depression, their preferences and other circumstances?
  • Do you know about newer therapies, such as MBCT, what they involve and for whom they might be suitable?
  • What factors do you consider when assessing whether a patient might benefit from computerised CBT? Do you encourage patients to feed back to you if they are struggling to complete a computerised CBT package?

Key questions for patients

  • Do you know about the different cognitive therapies that are available in your area?
  • Has your GP explained which ones might be most suitable for you?
  • Are you aware of what the therapy involves – for example, if it is delivered in a group or individually, or from your computer at home; and the time commitment required? 

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