Cognitive behavioural therapy (CBT) is most
effective in patients who have had four or more prior episodes of
depression, according to new research from The Netherlands.
The
study, published in the December issue of the British
Journal of Psychiatry, suggests GPs could use the number of
prior episodes to determine which patients are likely to benefit
most from therapy and prescribe treatment accordingly.
Researchers in The Netherlands studied 208
patients between the ages of 18 and 70 who were receiving treatment
for depression from their GP. Some of the participants were given
psychoeducation, others were given CBT plus psychoeducation, and
the rest carried on with their usual GP treatment.
The psychoeducation programme consisted of
three face-to-face sessions and short 3-monthly telephone contacts
after that. CBT plus psychoeducation consisted of 10-12 sessions
with a psychotherapist, followed by the psychoeducational
programme. All the participants were regularly assessed over a
period of two years to determine the severity of their
depression.
For patients who had three or fewer prior
episodes of depression, the three types of treatment performed
equally well. In other words, psychoeducation and CBT plus
psychoeducation did not have any significant effect on their
depression over the two-year period.
However, patients who had had four or more
prior episodes of depression did respond positively to CBT plus
psychoeducation.
The researchers said: “We found that in
patients with three or fewer prior episodes the three treatments
perform equally well, whereas in patients with four or more
episodes, CBT plus psychoeducation performs clinically better than
usual care. This effect is assumed to be attributable to the CBT
component of CBT plus psychoeducation, since psychoeducation did
not differ from usual care (although a favourable interaction
between psychoeducation and CBT cannot be ruled out
completely.”
The researchers continued: “Therefore, GPs may
consider the number of previous depressive episodes, which is a
strong predictor of an unfavourable course of depression, as a
treatment indicator in order to optimise allocation of scarce
treatment capacity. Patients with few prior episodes show no
additional benefit with CBT, whereas for patients with multiple
prior episodes, GPs may advise CBT in addition to usual care.”
For further information, please contact Liz Fox or Deborah
Hart in the Communications Department.
Telephone: 020 7235 2351 Extensions. 6298 or 6127
References:
Conradi HJ, de Jonge P and Ormel J (2008), Cognitive-behavioural therapy v. usual care in recurrent depression, British Journal of Psychiatry, 193: 505-506