Review finds psychological therapies are effective for adults with treatment-resistant depression

An NIHR-funded review has found that adults with treatment-resistant depression who are given psychotherapy in addition to usual care – taking antidepressants – had fewer depressive symptoms after six months, compared to those continuing with usual care. The researchers also found that patients who had psychotherapy – also known as talking therapy – in addition to usual care, were twice as likely to be depression free.

Antidepressants continue to be the first line treatment for patients with moderate or severe depression. However, many people prescribed antidepressants for depression will continue to have significant symptoms. This is called treatment-resistant depression. Little is known about what’s the best ‘next-step’ treatment for this group of patients. This Cochrane review of existing evidence aimed to find out whether talking therapies work for people with treatment-resistant depression.

The team, based at the University of Bristol and NIHR CLAHRC West, analysed data from six randomised trials. Such studies provide the best evidence of whether a treatment is of effective because participants are allocated at random to receive one of the treatments being compared.

The trials included 698 people in total and studied three types of psychotherapy. They all looked at whether adding psychotherapy to existing antidepressant treatment led to improvements in depressive symptoms, and if psychotherapy was acceptable to patients. In addition, to the positive outcomes seen at six months, beneficial effects of psychotherapy were also found in a smaller number of studies that looked at outcomes after 12 months and 46 months. Importantly, the researchers also found that providing psychotherapy in addition to usual care was as acceptable to patients as usual care alone.

Dr Nicola Wiles, from the Centre for Academic Mental Health, who led the study, said:

“This is encouraging news for people with treatment-resistant depression. Because of the size and quality of the studies in our review, we can say that psychotherapy is an effective treatment when given in addition to medication for this patient group. This highlights how important it is to invest in psychological services, to reduce the significant burden to patients and healthcare systems associated with non-response to the most common treatment for depression.

“But there are still many unanswered questions. We don’t know if there are any differences in the effectiveness of different types of psychotherapy for this patient group, or if switching to a psychological treatment would be more beneficial than continuing medication alone. Future studies need to answer these important questions.”