BJPsych Kaleidoscope January 2020

magazine-coverPreventing recurrence after recovery from a major depressive episode is a key clinical goal: but what are the best strategies?

During an acute episode, antidepressants and cognitive–behavioural therapy (CBT) are equally efficacious and their combination is typically shown to be superior to either alone. However, there are surprisingly few randomised controlled trials (RCTs) on the longer-term impact of CBT on major depressive episode recurrence, particularly when combined with medication. February’s Kaleidoscope reports on a trial of 292 individuals who had recovered from a chronic or recurrent major depressive episode through the use of antidepressant medication either with or without CBT. The participants in remission were randomised to either stay on their medication or have it gradually withdrawn, and followed up over 3 years. Those kept on antidepressants did substantially better than those taken off them, regardless of how they had initially attained remission. Interestingly, previous treatment with CBT did not have an impact on the likelihood of recurrence; this is all the more surprising given that those who received both interventions showed superior outcomes in the acute recovery phase. The authors raise an intriguing possibility that medication might interfere with the impact of CBT in the acute phase, and note that a CBT-only arm is needed in future studies.

Finally, reviewer 2, reviewer 2, what did we ever do to so upset you?

Although essential for protecting the integrity of research, we’re all familiar with the vagaries and, at times, sense of unfairness of the review process. A recent paper in the BMJ that analysed over six million journal articles showed that men generally used more superlatives in the abstracts of their work – such as ‘unique’, ‘first’, ‘excellent’ and ‘remarkable’ – which was subsequently more cited. Women authors appeared far more modest (or perhaps honest), and also typically had their work spend 3–6 months more under review. There has been less focus on qualitative content of reviews, and how this might have an impact on researchers’ sense of scientific worth. February’s Kaleidoscope describes an anonymous international survey of the experiences of researchers in science, technology, engineering and mathematics (STEM) subjects. Respondents across gender and ethnicity groups commonly reported having received unprofessional reviewer comments, something that had occurred to about half of those surveyed. However, underrepresented STEM groups were more likely to perceive a negative impact on their aptitude, productivity and career progression after such a review. White men were least likely to subsequently question their ability – perhaps they believe their own superlatives. There is never any need for unprofessional reviewing, and this survey suggests such rudeness has the most impact on those who should be most supported to advance diversity in our field. Reviewers have traditionally been protected by anonymity, and there are cogent arguments supporting this, but there perhaps needs to be an allied focus on the tone and content of reviews, as well as prospective analysis and redressing of gender differences in review time and acceptance rates. There is a problem in self-promotion and reviewing of science: it appears to be pale, male and stale.


(All questions true or false; full answers – and source material - will be in February’s Kaleidoscope column in the BJPsych)

  1. A randomised controlled trial of antidepressant continuation/discontinuation upon recovery from depression found that earlier treatment with cognitive behavioural therapy (CBT) had no impact on outcomes.
  2. A study has shown that research submitted by lead women authors typically spends an additional 3-6 months under review compared to that led by men.
  3. The largest meta-analysis of prospective studies of biomarkers for depression found no support for any of the assayed neuroimaging, gastrointestinal, immunological, neurotrophic, neurotransmitter or hormonal factors.


  1. True.
  2. True.
  3. False, but there was only evidence for cortisol.


Read the full January 2020 Kaleidoscope column in BJPsych.

Last month's quiz answers can be now be found in the December 2019 Kaleidoscope column.

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