• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN SA Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » Cognitive Behavioral Therapy for Treatment Resistant Depression

Cognitive Behavioral Therapy for Treatment Resistant Depression

March 1, 2013
From The Carlat Psychiatry Report
Issue Links: Learning Objectives | Editorial Information | PDF of Issue
Subject:
Depression

Short Description:
Cognitive Behavioral Therapy for Treatment Resistant Depression

Background:
We have an abundance of medications to treat depression, but “treatment resistance” remains all too common. Accordingly, there has been a rise in the number of “augmentation” or “adjunctive” medications to address this population. Unfortunately, comparable attention has not been drawn to the role of psychotherapy in the management of treatment-resistant depression.To evaluate the effect of psychotherapy on treatment-resistant depression, investigators recruited 469 patients with depression who had taken antidepressants (mostly SSRIs) for at least six weeks without a response—their definition of “treatment resistance.” They randomized patients to usual care (which included medications and any other treatment options selected by their general practitioner) or usual care plus cognitive behavioral therapy (CBT). CBT was delivered by part-time therapists, nine of whom conducted the vast majority of therapy. Patients completed a mean of 6.3 months of treatment, with a median of 11 sessions of CBT over the first six months.At the end of six months, nearly half (46%) of the patients randomized to CBT met criteria for treatment response (defined as a decrease of >50% in scores on the Beck Depression Inventory, BDI), compared with only 22% of the usual care group, with a threefold increased odds of response (odds ratio of 3.26). Patients undergoing CBT were also more likely to experience remission (BDI score <10) (28% vs 15%) and have fewer symptoms of anxiety or panic at the end of six months. On average, BDI scores were 5.7 points lower in the intervention group, with an effect size of 0.53. The number needed to treat (NNT) for response was 4, while the NNT for remission was 8.Those who had experienced CBT within the last three years were excluded, as were those with bipolar disorder, psychosis, or a substance use disorder. Adherence to medications was high in both groups, although fewer than half of the patients experienced a change in dose over the course of their treatment (Wiles N et al, Lancet 2013;381(9864):375–384).

TCPR’s Verdict: Treatment resistance in depression is widespread, and common solutions include switching to a different antidepressant or adding another medication to augment the first. This study is the first large-scale, randomized trial of CBT as an “augmenting agent,” and shows that CBT is highly effective in reducing symptoms of depression and even in helping to achieve remission.
General Psychiatry
KEYWORDS free_articles practice_tools_and_tips
www.thecarlatreport.com
Issue Date: March 1, 2013
SUBSCRIBE NOW
Table Of Contents
Measuring the Quiet Man: Estimating Risk of Violence
Fighting in the Trenches: A Practical Guide to Violence Risk Assessment and Management
Patients, Families, and the Legal System
Cognitive Behavioral Therapy for Treatment Resistant Depression
DOWNLOAD NOW
Featured Book
  • MFB6eCover.jpg

    Medication Fact Book for Psychiatric Practice, Sixth Edition (2022)

    Guidance, clinical pearls, and bottom-line assessments covering the medications you use in your...
    READ MORE
Featured Video
  • therapist_canstockphoto9201097.jpg
    General Psychiatry

    Using SAMe In Clinical Practice with Garrett Rossi, MD

    Read More
Featured Podcast
  • KellieElvis2.jpeg
    General Psychiatry

    Elvis Presley and Pharmacokinetics - Part 2

    This common pharmacokinetic reaction will help you manage many bad medication reactions in psychiatric practice. But did it lead to Elvis Presley’s death? 

    Listen now
Recommended
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png

About

  • About Us
  • CME Center
  • FAQ
  • Contact Us

Shop Online

  • Newsletters
  • Multimedia Subscriptions
  • Books
  • eBooks
  • ABPN Self-Assessment Courses

Newsletters

  • The Carlat Psychiatry Report
  • The Carlat Child Psychiatry Report
  • The Carlat Addiction Treatment Report
  • The Carlat Hospital Psychiatry Report
  • The Carlat Geriatric Psychiatry Report

Contact

info@thecarlatreport.com

866-348-9279

PO Box 626, Newburyport MA 01950

Follow Us

Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

© 2023 Carlat Publishing, LLC and Affiliates, All Rights Reserved.