Comments on: ‘Psychotherapy Works’ Is Still News to Many

By: Ann Jorn, Ph.D.

Ann Jorn, Ph.D. — Fri, 30 Jan 2009 16:02:23 +0000

To take your point about primary car physicians not referring for psychotherapy, i would like to refer you to a study by Kravizt et al. (2006. They studied referral rates by primary care physcians for psychotherapy for patients diagnosed with adjustment disorder symptoms or major depression. Patients made 289 visits to various medical practices. Only 36% of physicians referred patients for mental health services. This referral rate is especially bad for those who suffer from chronic pain a population that has a high rate of depression. In a national survey, Bao, Sturm , and Croghan (2003) found that of those meeting criteria for major depression or dysthymia (N=1486), 63% had comorbid chronic pain conditions. These patients had 20% more primary care visits and were 20% less likely to see a mental health specialist than depressed, non-pain patients.

By: Suzanne

Suzanne — Wed, 28 Jan 2009 16:49:07 +0000

For me I couldn’t fully participate in therapy & get benefit from it without being on medication to lift the depression (I tried for years with just therapy). I was just stuck in this deep depression that clouded my thinking & judgment to such an extent that I couldn’t seem to get any insight or implement any changes in my life that I should have gained from therapy & I tried several different therapists, too.

Once I got my thinking cleared & my depression lifted with medication, I was able to get so much benefit from individual therapy & dialectical behavioral therapy group. I am now in the process of discontinuing some of my medications & decreasing the dosages of others (I take quite a few for bipolar 1 disorder) as I have learned so many new coping skills from therapy & have actually been able to change some life-long negative thinking patterns & learned excellent techniques to help reduce stress & anxiety. Some meds I still need, but the therapy has given me tools to enable me to get off others that I needed initially to even function enough to benefit from therapy.

By: Anonymous

Anonymous — Sun, 25 Jan 2009 17:01:49 +0000

The protocol and sample consent forms for the Treatment for Adolescents With Depression Study (TADS) may be found on the study Web site:
https://trialweb.dcri.duke.edu/tads/templates.html

By: Anonymous

Anonymous — Sun, 25 Jan 2009 08:19:29 +0000

And here is yet another recent publication by the same author—the “no harm done” study:
http://ajp.psychiatryonline.org/cgi/content/abstract/appi.ajp.2008.08040487v1

“At week 36, the response rate was 82% in the placebo/open group and 83% in the active treatment groups. The remission rate was 48% in the placebo/open group and 59% in the active treatment groups, a difference that approached statistical significance.

Remission rates at 9 months were lower in patients treated initially with placebo, but 3 months of placebo treatment was not associated with any harm or diminished response to subsequent treatment.”

Key words: “approached” statistical significance

Again, according to ClinicalTrials.gov, up to 432 subjects were to be enrolled. Where did the extra 7 subjects come from? And the data could be 4 – 10 years old:
http://www.clinicaltrials.gov/ct2/show/NCT00006286?term=emslie+tads&rank=1

Here are two news releases on the study:
http://www.utsouthwestern.edu/utsw/cda/dept353744/files/513040.html

http://www.nimh.nih.gov/science-news/2009/adolescents-with-depression-not-harmed-in-studies-using-placebo.shtml

By: Anonymous

Anonymous — Sun, 25 Jan 2009 06:58:19 +0000

Here is a recent publication by the same author, different study:
http://journals.lww.com/jaacap/Abstract/2009/02000/Remission_and_Recovery_in_the_Treatment_for.12.aspx

“At week 36, the estimated remission rates for intention-to-treat cases were as follows: combination, 60%; fluoxetine, 55%; cognitive-behavioral therapy, 64%; and overall, 60%.”

According to ClinicalTrials.gov, up to 432 subjects were to be enrolled. Where did the extra 7 subjects come from? As well, the data could be 4 – 10 years old:
http://www.clinicaltrials.gov/ct2/show/NCT00006286?term=emslie+tads&rank=1

Compare these results with a prior study:
http://www.nimh.nih.gov/science-news/2007/depressed-adolescents-respond-best-to-combination-treatment.shtml

NIMH has not posted a news release about this study on its Web site, yet.

By: Survivors News and Reviews » Blog Archive » Psychotherapy Works

Survivors News and Reviews » Blog Archive » Psychotherapy Works — Sat, 24 Jan 2009 19:54:03 +0000

[...] ‘Psychotherapy Works’ Is Still News to Many In the U.S., consumers are constantly bombarded with pharmaceutical advertising describing the many benefits of different psychiatric medications (”Depression hurts…” No duh!). But consumers get no marketing about the benefits of psychotherapy, and often still have old, stigmatizing misconceptions about how it works and how expensive it is. (No, you don’t lie down on a couch and no, it doesn’t take 10 years before psychotherapy starts helping.) [...]

By: What is Depression?

What is Depression? — Sat, 24 Jan 2009 15:32:27 +0000

[...] “Psychotherapy Works” is Still News to Many [...]

By: Dr. Charles Elliott

Dr. Charles Elliott — Fri, 23 Jan 2009 23:55:58 +0000

Great blog! I’d like to add that research on the effectivness of psychotherapy combined with medication does not always show a major benefit from adding medication to therapy. There are times that adjunctive medication does boost the overall outcome, but this benefit is often fairly small. This fact is surprising since the effects of medication and psychotherapy are both fairly large and you’d think that combining them would almost doubl the benefit.

For example, in the treatment of obsessive compulsive disorder, behavior therapy in the form of exposure and response prevention works at least as well as medication and does better at preventing relapse. I often recommend that clients try a thorough regimen of behavior therapy first and consider adding medication only if they don’t achieve the success they want.

By: AA

AA — Fri, 23 Jan 2009 22:39:40 +0000

The Furious Seasons blog posted a similar type entry in 2007:

Prozac And CBT Help Treat Depression In Teens

http://tinyurl.com/d72bnx

Initially, combination therapy worked the best by a significant margin. But by week 36, here were the results:

86% for combination therapy, 81% for fluoxetine therapy, and 81% for CBT at week 36. Suicidal ideation was slightly less with CBT vs. combination therapy. And alot more with fluoxetine.

Anyway, I am just wondering if this study is typical in that the longer you go about, the closer CBT will come to combination therapy.