Still Feeling Depressed Despite Meds?

Cognitive behavioral therapy effective for depression when antidepressants fail

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Antidepressants are great for treating depression – when they work. But what about depressed patients who don't get better with antidepressants? They could try a certain talk therapy.

That therapy is cognitive behavioral therapy (CBT). This type of talk therapy helps patients change how they think to improve their feelings and behavior.

A recent study has found CBT was effective for a group of patients that weren't helped by antidepressants.

"Ask about cognitive behavioral therapy."

The study was led by Nicola Wiles, PhD, from the Center of Mental Health, Addiction and Suicide Research within the School of Social and Community Medicine at the University of Bristol in the United Kingdom.

The researchers recruited 469 patients between the ages of 18 and 75 who all had depression which did not improve after at least six weeks of taking antidepressants.

The patients were randomly split into two groups. One was given usual care and the other was given CBT in addition to usual care. The patients were tracked for a year.

The researchers were only able to track 422 of the patients for six months and 396 for the full year.

After six months, 46 percent of those in the CBT group (95 patients) had at least a 50 percent reduction in their depression symptoms. Only 22 percent (46 individuals) in the usual care group experienced a 50 percent decrease in their symptoms.

This beneficial effect of the cognitive behavioral therapy still remained at the end of the year.

"This large and well designed study provides strong evidence that cognitive behavior therapy is a very useful treatment for persons with depression who do not improve sufficiently with antidepressant medication," said Jesse Wright, MD, PhD, the Director of the Depression Center in the Department of Psychiatry and Behavioral Sciences at the University of Louisville.

"Smaller studies done previously have found similar results," Dr. Wright told dailyRx. "But this study should encourage clinicians and healthcare systems to put the research findings into practice. Cognitive behavior therapy appears to offer considerable hope for those who suffer from treatment resistant depression." Dr. Wright is not affiliated with this study.

Having another avenue of therapy that is effective at treating depression is important for those who do not respond to antidepressants, the authors wrote.

"While drug treatments can be very effective, not all patients will respond well to treatment. For some patients, the experience of depression can be particularly difficult," said co-author John Campbell, MD, in a release.

"GPs and their patients can take real encouragement from these findings which provide real support for the use of CBT in patients where other treatments may have failed," Dr. Campbell said.

The study was published December 6 in The Lancet. The research was funded by the National Institute for Health Research Health Technology Assessment program.

One author is a past president of the British Association for Behavioral and Cognitive Psychotherapies (BABCP) and has written books on depression. Another author co-founded Mood Disorders Center and has taught, lectured and written a book on cognitive therapy.

A third author is the clinical lead at the Nottingham Specialized Depression Service, a past president of BABCP, is working on another depression study, has led workshops about CBT and has written books on depression. No other conflicts of interest were noted.

Reviewed by: 
Review Date: 
December 6, 2012
Last Updated:
December 13, 2012