Research Update: Psychotherapy and Depression
Four studies published recently in depression and bipolar disorder suggest some different and unique benefits of psychotherapy. This is a long entry, so you’ll have to “read more” to get the full story.
Treatment Resistance in Depression
Lekin and associates examined 240 patients with moderate-to-severe major depressive disorder to see how cognitive therapy helps in people who have tried various types of antidepressant medications (without relief from their depression):
Recent research suggests that there may be a reduction in therapeutic response after multiple administrations of antidepressant drug (AD) therapy in patients with major depressive disorder. This study assessed the response to AD therapy and cognitive therapy (CT) of patients with a history of prior AD exposures.
The subjects in the study entered a randomized controlled trial comparing pharmacotherapy with paroxetine (Paxil) to cognitive therapy and treatment was administered for 16 weeks. Although this study only looked at Paxil, the researchers found that more prior antidepressant medication exposures predicted a poor response to treatment with Paxil, but not to cognitive therapy.
If these findings are replicated in methodologically rigorous studies of paroxetine and other antidepressants, cognitive therapy should be recommended, in preference to antidepressant medications, for patients [who’ve tried multiple, different antidepressants in the past].
This is consistent with the STAR*D findings, that it takes multiple trials with different antidepressants in order to find effective results in most people. This new study suggests cognitive therapy is, possibly, an even more effective treatment option to pursue.
Telephone-based Cognitive Behavioral Therapy in Primary Care
What if you took a time-tested treatment, cognitive-behavioral therapy, and transplanted it into a new setting (your doctor’s office) and a new modality (by telephone)? Would it still be able to help people with depression?
Well, Lund and his colleagues did exactly that with 393 people, to evaluate the effective of telephone-based cognitive-behavioral therapy, versus usual care for people taking an antidepressant in a primary care setting (e.g., your family doctor’s office). They found that adding a brief, structured cognitive-behavioral therapy program — administered by the telephone! — can significantly improve clinical outcomes for these people with depression. Easy, well-understood, and effective. I hope docs take note.
Intensive Psychotherapy More Effective Than Brief Treatment
Clinicians often suspect that longer-term, intensive psychotherapeutic interventions are more effective than brief, psychoeducational interventions. Research by Miklowitz and friends suggest that the suspicion is true and furthermore, that the actual specific type of intensive psychotherapy (family-focused, interpersonal, or cognitive-behavioral) didn’t matter:
Intensive psychosocial treatment as an adjunct to pharmacotherapy was more beneficial than brief treatment in enhancing stabilization from bipolar depression.
What this basically means that if you have bipolar disorder, and are just in medication management appointments or tried a brief treatment, you’re not doing as well as if you were also in regular psychotherapy too.
Long-term Protection Against Depression
People with depression often experience a frustrating fall back into depression months or even years after their initial episode, due to life events, stress, or other factors. People who experience this decline often find themselves back to taking medications. But what if psychotherapy provided some protection (or “resiliency”) in grappling with future episodes of depression?
Turns out, psychotherapy does just that.
Hawley and his associates looked at 153 people enrolled in an outpatient setting to assess long-term effectiveness of treatments:
Results supported a stress reactivity model in that stressful events led to elevations in the rate of depression change. Furthermore, […] this longitudinal stress reactivity occurred only for outpatients in the medication conditions. Results demonstrate that the enduring impact of psychotherapy involves the development of enhanced resiliency to stressful life events.
So there you have it. Another study showing that psychotherapy, but not medication, provides an enduring effect by reducing depressive vulnerability following the end of treatment.
Hawley LL, Ringo Ho MH, Zuroff DC, Blatt SJ. (2007). Stress reactivity following brief treatment for depression: differential effects of psychotherapy and medication. J Consult Clin Psychol. 2007 Apr;75(2):244-56.
Leykin Y, Amsterdam JD, DeRubeis RJ, Gallop R, Shelton RC, Hollon SD. (2007). Progressive resistance to a selective serotonin reuptake inhibitor but not to cognitive therapy in the treatment of major depression. J Consult Clin Psychol. 2007 Apr;75(2):267-76.
Ludman EJ, Simon GE, Tutty S, Von Korff M. (2007). A randomized trial of telephone psychotherapy and pharmacotherapy for depression: continuation and durability of effects. J Consult Clin Psychol. 2007 Apr;75(2):257-66.
Miklowitz DJ, Otto MW, Frank E, Reilly-Harrington NA, Wisniewski SR, Kogan JN, Nierenberg AA, Calabrese JR, Marangell LB, Gyulai L, Araga M, Gonzalez JM, Shirley ER, Thase ME, Sachs GS. (2007). Psychosocial treatments for bipolar depression: a 1-year randomized trial from the Systematic Treatment Enhancement Program. Arch Gen Psychiatry. 2007 Apr;64(4):419-26.
Grohol, J. (2018). Research Update: Psychotherapy and Depression. Psych Central. Retrieved on April 7, 2020, from https://psychcentral.com/blog/research-update-psychotherapy-and-depression/