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Use CBT for treatment-resistant depression, GPs told

GPs should consider referring for cognitive behavioural therapy in patients with treatment-resistant depression, say the results of a new trial.

UK researchers randomised 469 adult patients with treatment-resistant depression - i.e. symptoms despite adherence to an antidepressant for at least six weeks - to receive either CBT as an adjunct to usual care or usual care alone.

Patients undergoing CBT as an adjunct to usual GP care were more than three times as likely to experience a 50% reduction in depressive symptoms, compared to patients who underwent usual care alone.

They were also more than two times likely to go into remission, defined as a Beck Depression Index score of less than 10, compared to patients being treated by usual GP care.

There were no restrictions placed on GPs when it came to usual care, while the intervention group received 12 sessions of CBT.

The UK researchers say this is the first large scale randomised controlled trial showing CBT is an effective next-step for depressed patients who have not responded to pharmacotherapy.

Lancet 2012, available online 7 December

 

Readers' comments (6)

  • Vinci Ho

    The category of depressed patients who will respond well to CBT is still those with mild to moderate depression. After a good course if six to nine months antidepressant for severe depression , remission may not be achieved but the severity of symptoms is so often lessened but still residual e.g. Phq7 score goes down. In essence , the depression becomes moderate, that is a very good time to commence CBT. I use CBT on my patients in these circumstances and it works well......

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  • Hazel Drury

    I think you'll find that CBT is high up there before antidepressants in the NICE guidelines. The problem is of course there are no psychothepuetic therpies to whom I can refer on the NHS in North Wales unless the patient is unemployed (fit for work scheme), sucidal (CPN) or psychotic.

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  • Hazel Drury

    Should have said therapies, not therpies, which sounds more like some kind of zoster infection.

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  • Vinci Ho

    Correction
    PHQ9 not 7

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  • Doctor McDoctor Face

    Most GPs will be needing this soon.

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  • 'If they don't respond to treatment'? CBT ...IS aTREATMENT....! There should be a mutual decision as to what is the best and what is preferred not just shoving people on anti depressant even if CBT is not available. Hazel's claim by the way is ridiculous .since when are people in the groups she describes are offered CBT.especailly those suffering from psychosis!!!

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