When Antidepressants Don't Work, Give Counseling a Try12/07/12
THURSDAY, Dec. 6 (HealthDay News) -- People suffering from
depression who don't respond to antidepressants alone may find
relief if they also undergo cognitive behavioral therapy, a new
British study suggests.
Many of the two-thirds of those with depression who do not
respond fully to antidepressants are three times more likely to
improve with cognitive behavioral therapy, the researchers
"When people with depression have not responded to treatment with antidepressants, receiving cognitive behavioral therapy in addition to continuing on medication as part of usual care, reduces depressive symptoms and improves quality of life," said lead researcher Nicola Wiles, a senior lecturer in epidemiology at the University of Bristol.
The finding emphasizes the importance of investing more in
psychological services, she said.
"In many countries, access to cognitive behavioral therapy is limited to those who can afford it. Even in the U.K., 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 cognitive behavioral therapy that takes 12 to 18 sessions," Wiles said.
"By investing in psychological services, it is possible to reduce the significant burden to patients that is associated with non-response to the most common treatment for depression," she added.
According to the National Association of Cognitive-Behavioral
Therapists, cognitive behavioral therapy, unlike other so-called
talk therapy, "is based on the idea that our thoughts cause our
feelings and behaviors, not external things, like people,
situations and events. The benefit of this fact is that we can
change the way we think to feel and act better even if the
situation does not change."
The report was published online Dec. 7 in
To test the value of cognitive behavioral therapy, Wiles' team
randomly assigned more than 400 people who suffered from depression
and who had not responded to six weeks of antidepressant therapy to
continue their medications, some while receiving cognitive
behavioral therapy and others not.
After six months, the researchers found that 46 percent of those
receiving cognitive behavioral therapy improved, compared with 22
percent of those on antidepressants alone.
Improvement was pegged at a minimum 50 percent reduction in
depressive symptoms, the researchers noted.
People receiving cognitive behavioral therapy were also more
likely to not have any symptoms of depression or anxiety. And the
results held a year later, the researchers added.
In Britain, about 3 percent of adults report being depressed. In
the United States, about 7 percent of adults suffer from
depression, the researchers noted.
By 2030, depression is expected to be the leading cause on
disability in high-income countries, they added.
"An inadequate treatment response to antidepressant medication is an all-too-frequent outcome for depressed patients," said Michael Otto, a professor of psychology at Boston University and co-author of an accompanying journal editorial.
This study addresses this issue by showing that cognitive
behavioral therapy is an useful next step for these patients, he
"Patients have a choice about treatment, either when initiating care or when trying to improve treatment response if the first option does not work," Otto said. "Cognitive behavioral therapy should figure highly in these treatment choices."
Simon Rego, director of psychology training at Montefiore
Medical Center/Albert Einstein College of Medicine in New York
City, said "there is a great deal of evidence that supports
cognitive behavioral therapy as a first-line treatment for
depression, it is often also suggested as a next-step treatment
option for patients in primary care who have not responded to their
"This study adds to the already large evidence base in support of cognitive behavioral therapy for the treatment of depression," Rego said. "These results should provide hope to a wide range of depressed patients who are initially prescribed an antidepressant but fail to respond fully to it."
For more on depression, visit the
U.S. National Institute of Mental Health.
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Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.