Combining cognitive behavioral therapy (CBT) with antidepressants as treatment for people with depression is three times more likely to make them feel better when antidepressants alone fail to work. This news, published Online First in The Lancet, is very promising for the two thirds of those with depression who haven’t seen any improvements from antidepressant use alone.

Depressive patients who do not respond to targeted medication tend to have recurring bouts of depression. Dutch scientists in a previous study in 2008, found that CBT is very effective among those with recurrent depression.

Nicola Wiles, leader of the study from the University of Bristol, said:

“Until now, there was little evidence to help clinicians choose the best next step treatment for those patients whose symptoms do not respond to standard drug treatments”

CBT is a form of therapy that tries to change a patients pattern of thoughts and behavior, it follows the belief that by doing so their overall mood will improve, relieving many of the symptoms of depression.

The study monitored 469 adults from 73 general practices (aged 18-75) who went through 6 weeks of treatment on an antidepressant but didn’t see any improvement. They were split into two different groups, one group of 235 patients continued pure antidepressant medication treatment while the other group of 234 patients received usual care treatment along with CBT. The follow up period was 12 months.

They found that 46% of participants who received CBT as well as usual care saw improvements after 6 months compared to only 22% among those who solely used antidepressants. Those in the CBT group experienced less anxiety and were more likely to go into remission and experienced fewer and milder symptoms than those in the other group, with a reduction of depressive symptoms of at least 50%.

Depression is the fourth leading disability in the world and one of the most common psychiatric disorders,it affects over 350 million people worldwide, according to the World Health Organization (WHO) and nearly 7% of adults in the USA develop it every year. The condition is predicted by 2030 to be the main cause of disability in developed nations.

Nicola Wiles added:

“In many countries access to CBT is limited to those who can afford it. Even in the UK where there has been substantial investment in psychological services, many people who have not responded to antidepressants still do not receive more intensive psychological therapies such as CBT that take 12 to 18 sessions. In the USA, only about a quarter of people with depression have received any form of psychological therapy in the last 12 months.”

The UK Government recently spent £500 million on the Improving Access To Psychological Therapies (IAPT) scheme, which according to Michael Otto from Boston University, USA, and Stephen Wisniewski from the University of Pittsburgh, USA, is very promising:

“(These findings) add to the already impressive efficacy for CBT as assessed for other stages of treatment …If the broader IAPT vision is realised, it has the potential to serve as a model for depression treatment for other nations.”

CBT is a short-duration treatment mainly for specific mental problems, such as panic attacks, phobias, anxiety, eating disorder and depression.

Psychologists say that CBT is a combination of cognitive therapy and behavioral therapy.

Cognitive therapy – focuses on our thoughts, beliefs and attitudes.

Behavioral therapy – focuses on how we behave in response to those thoughts.

Some people may have acquired unhealthy ways of thinking and behaving over many years or decades. The CBT therapist, who uses a set of structured techniques, sets out to identify thinking that causes troublesome feelings and problematic behavior. The patient (client) is then taught how to change this thinking, resulting in more appropriate and positive responses.

For example:

    Negative thoughts usually end up upsetting us, leading to angry feelings, which then impact on our mood and behavior.

    If such thoughts are not countered with a more positive approach, a negative spiral will follow, which can distort a person’s perceptions of things.

    CBT tries to get the person to challenge their beliefs about themselves and what they are capable of, so that their view of things or their situation is more realistic.

A study carried out by researchers from John Hopkins University found that using computers late at night can be a cause of depression due to the exposure to bright light late at night which elevates levels of a certain stress hormone.

Magnetic stimulation of the frontal lobe of the brain is effective at reducing symptoms of depression without the adverse side effects antidepressants have on sleep or arousal.

Written by Joseph Nordqvist