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Treatment for depression that hasn’t responded to medication

An NIHR study has found that individual, face to face cognitive behavioural therapy (CBT) used alongside anti-depressant medication, was effective for people with depression who had not responded to treatment with antidepressants alone.

There is already evidence suggesting CBT is effective for depression that hadn’t been treated before and for people with chronic depression. But this is first large scale trial to evaluate whether using CBT in combination with anti-depressants might be more effective than continuing anti-depressants alone, for people who had not responded to initial treatment.

Antidepressant medication is commonly prescribed to people who report moderate symptoms of depression. However a recent study found that only one third of patients responded fully to this form of treatment, and half did not experience a significant decrease in their symptoms. When people do not get better after receiving the standard medication for an adequate period of time, this is known as treatment-resistant depression. There is little evidence that approaches such as increasing the dose of medication or switching to an alternative drug are effective.

The study was a randomised trial with nearly 500 participants from 73 GP practices. One group of patients was offered usual care that included continuing on their anti-depressant medication, while a second group received a course of 12-18 sessions of individual, face-to-face CBT in addition to medication. After six months, 46% of people who had received the CBT reported that their symptoms had reduced by at least a half, compared to just under 22% of people in the group receiving medication only.

People who had received CBT also reported greater improvements in their quality of life. Benefits were still evident up to four years after the treatment. While there was an additional cost associated with delivering the CBT, this was still found to be cost-effective when compared to the gain in health experienced by participants.

The researchers interviewed a number of the participants about their experiences of CBT. Most participants felt the therapy had been helpful, even those who had not completed the course. However many also reported that the therapy was challenging, often because of practical difficulties in attending sessions or because of problems with the homework element. Patients with other health conditions seemed to find it particularly challenging.

These findings are in line with NICE guidance, which suggests offering a combination of high-intensity psychological therapy and drug treatment together for people with moderate to severe depression, particularly those who have not responded to other treatments.

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