older psychiatryPeople with depression that has not responded fully to treatment with antidepressants experience long-term benefits from cognitive behavioural therapy (CBT) when it is used in addition to their usual treatment, a new study has found. 

The University of Bristol study found when CBT was given in addition to usual care, including antidepressants, it was effective in reducing depressive symptoms and improving quality of life over a significant period of time. On average, people whose depression had not responded to medication experienced mental health benefits for 46 months. 

Over the course of 46 months, 43% of those who had received CBT had improved, reporting at least a 50% reduction in symptoms of depression, compared with 27% who continued with their usual care alone. Importantly, the study also found that this type of ‘high intensity’ CBT was a cost-effective treatment from the perspective of the health service.

Dr Nicola Wiles, from the School of Social and Community Medicine at the University of Bristol, said: “Antidepressants are often prescribed for people with depression, but we know that many people don’t fully respond to such treatment. CBT is a way of helping people with depression change the way they think in order to improve how they feel, and to change what they do. It’s an educational approach, in which the patient learns skills to help them better manage their mood. 

“We previously found that CBT was an effective treatment reducing depressive symptoms and improving quality of life over 12 months for patients who hadn’t responded to antidepressants, but before this study, there was very little evidence about the effectiveness of CBT over the long-term.

“Our results show the importance of investment in psychological services. While there have been initiatives to increase access to such treatments in both England and Australia, these have mainly focussed on increasing ‘low intensity’ programmes, such as computerised CBT packages and guided self-help, for which there is little evidence of long-term effectiveness. Our study suggests that by investing in ‘high intensity’ CBT as delivered in the CoBalT trial, it is possible to reduce the significant burden to patients and healthcare systems that is associated with non-response to the most common treatment for depression.”

The research was conducted by academics at the University of Bristol, along with colleagues from the Universities of Exeter, Oxford, Glasgow, and University College London. Their paper, ‘Long-term effectiveness and cost-effectiveness of cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment resistant depression in primary care: follow-up of the CoBalT trial’ is published in The Lancet Psychiatry. The research was funded by the National Institute for Health Research Health Technology Assessment.