Psychological Therapies for Treatmentresistant Depression in Adults

Summary

A Cochrane review [Abstract] 1 included 6 studies with a total of 698 subjects. Most participants were women approximately 40 years of age. All studies evaluated psychotherapy plus usual care with antidepressants vs. usual care with antidepressants. Three studies compared the addition of cognitive-behavioural therapy (CBT) to usual care (n = 522), and one each evaluated intensive short-term dynamic psychotherapy (ISTDP) (n = 60), interpersonal therapy (IPT) (n = 34) or group dialectical behavioural therapy (DBT) (n = 19). Psychotherapy given in addition to usual care improved self-reported depressive symptoms (MD -4.07 points, 95% CI -0.07 to -1.07 on the Beck Depression Inventory (BDI) scale; 5 trials, n = 575) over the short term (up to 6 months). Effects were similar when data from all 6 trials were combined for self-reported depressive symptoms (SMD -0.40, 95% CI -0.65 to -0.14; n = 635). Similar benefit was seen on the Patient Health Questionnaire -9 Scale (PHQ-9) (MD -4.66, 95% CI 8.72 to -0.59; 2 trials, n = 482) and on the Hamilton Depression Rating Scale (HAMD) (MD -3.28, 95% CI -5.71 to -0.85; 4 trials, n = 193). There was no differential dropout between intervention and comparator groups over the short term (RR 0.85, 95% CI 0.58 to 1.24; 6 studies; n = 698). Remission (RR 1.92, 95% CI 1.46 to 2.52; 6 trials, n = 635) and response (RR 1.80, 95% CI 1.2 to 2.7; 4 trials, n = 556) analyses indicate that psychotherapy was beneficial as an adjunct to usual care over the short term. With the addition of CBT, depression scores were lower on the BDI scale over the medium term (12 months) (RR -3.40, 95% CI -7.21 to 0.40; 2 studies; n = 475) and long term (46 months) (RR -1.90, 95% CI -3.22 to -0.58; one study; n = 248).