Subject:
Psychotherapy

Short Description:
Adding CBT to meds is effective, but slow.

Background:
The results of the cognitive therapy component of the NIMH-funded STAR-D trial were finally released. Recall that in STAR-D, about 4,000 depressed patients were initially enrolled and were all given Celexa (citalopram) at an average dose of about 40 mg/day (see TCPR January 2007 for a rundown of STAR-D findings). Of the initial 4,000, about 1,500 patients either did not respond or did not tolerate Celexa, and were assigned to a variety of medication or psychotherapy trials. Patients randomized to augmentation of their Celexa with CBT had similar remission rates to those who received either Wellbutrin or BuSpar augmentation. However, CBT augmentation was slower, taking about 55 days to work, vs. medication’s 40 days. On the other hand, patients who were randomized to switching from Celexa to either CBT or another antidepressant responded identically to both strategies, with no time course difference (Thase ME, et al., Am J Psychiatry 2007;164:739-752).

TCPR's Take:
For patients who do not respond to an adequate SSRI trial, augmenting with either Wellbutrin or BuSpar appears to work faster than adding CBT, although meds can cause more side effects. However, since STAR-D’s design was not placebo-controlled, blinded, nor fully randomized, it is difficult to have a great deal of confidence in any of its findings, including this one.