Cognitive Behavioral Therapy (CBT) can reduce symptoms of depression in people who fail to respond to drug treatment, found a new study in the Lancet.
CBT, a type of psychotherapy, was found to benefit nearly half of the 234 patients who received it combined with normal care from their GP.
Up to two-thirds of people with depression do not respond to anti-depressants.
Patients should have access to a range of treatments, the charity Mind said.
CBT is a form of talking psychotherapy to help people with depression change the way they think to improve how they feel and alter their behavior.
The study followed 469 patients with treatment-resistant depression picked from GP practices in Bristol, Exeter and Glasgow over 12 months.
One group of patients continued with their usual care from their GP, which could include anti-depressant medication, while the second group was also treated with CBT.
After six months, researchers found 46% of those who had received CBT reported at least a 50% reduction in their symptoms.
This compared with 22% experiencing the same reduction in the other group.
CBT is a form of talking psychotherapy to help people with depression change the way they think to improve how they feel and alter their behavior
The study concluded CBT was effective in reducing symptoms and improving patients’ quality of life. The improvements had been maintained for a period of 12 months, it added.
The patients who did benefit from cognitive behavioral therapy spent one hour a week with a clinical psychologist learning skills to help change the way they think.
Chris Williams, professor of psychosocial psychiatry at the University of Glasgow, and part of the research team, said: “The research used a CBT intervention alongside treatment with anti-depressants. It confirms how these approaches – the psychological and physical – can complement each other.
“It was also encouraging because we found the approach worked to good effect across a wide range of people of different ages and living in a variety of settings.”
WHAT IS CBT?
Cognitive Behavioral Therapy is:
- a way of talking about how you think about yourself, the world and other people
- how what you do affects your thoughts and feelings
CBT can help you to change how you think (cognitive) and what you do (behavior).
Unlike some other talking treatments, it focuses on the “here and now” instead of the causes of distress or past symptoms.
Canadian researchers, who examined the impact of the medications on the whole body, say common anti-depressants could be doing patients more harm than good.
Researchers at McMaster University examined previous patient studies into the effects of anti-depressants and determined that the benefits of most anti-depressants compare poorly to the risks, which include premature death in elderly patients.
“We need to be much more cautious about the widespread use of these drugs,” said study leader and evolutionary biologist Paul Andrews.
“It’s important because millions of people are prescribed anti-depressants each year, and the conventional wisdom about these drugs is that they’re safe and effective.”
Anti-depressants are designed to relieve the symptoms of depression by increasing the levels of serotonin in the brain, where it regulates mood.
The vast majority of serotonin that the body produces, though, is used for other purposes, including digestion, forming blood clots at wound sites, reproduction and development.
The researchers, whose study was published in the online journal Frontiers in Psychology, found that anti-depressants had negative health effects on all processes normally regulated by serotonin.
This included a higher risk of developmental problems in infants, problems with sexual function, digestive problems and abnormal bleeding and stroke in the elderly.
The authors reviewed three recent studies showing that elderly anti-depressant users are more likely to die than non-users, even after taking other important variables into account. The higher death rates indicate that the overall effect of these drugs on the body is more harmful than beneficial.
The higher death rates among anti-depressants users indicate that the overall effect of these drugs on the body is more harmful than beneficial
“Serotonin is an ancient chemical. It’s intimately regulating many different processes, and when you interfere with these things you can expect, from an evolutionary perspective, that it’s going to cause some harm,” Paul Andrews said.
Millions of people are prescribed anti-depressants every year, and while the conclusions may seem surprising, Paul Andrews says much of the evidence has long been apparent and available.
“The thing that’s been missing in the debates about anti-depressants is an overall assessment of all these negative effects relative to their potential beneficial effects,” he says.
“Most of this evidence has been out there for years and nobody has been looking at this basic issue.”
In previous research, Paul Andrews and his colleagues had questioned the effectiveness of anti-depressants even for relieving depression. They found patients were more likely to suffer relapse after going off their medications as their brains worked to re-establish equilibrium.
Paul Andrews says it is important to look critically at their continuing use.
“It could change the way we think about such major pharmaceutical drugs,” he said.
“You’ve got a minimal benefit, a laundry list of negative effects – some small, some rare and some not so rare. The issue is: does the list of negative effects outweigh the minimal benefit?”
Walking could play an important role in fighting depression, according to researchers in Scotland.
Vigorous exercise has already been shown to alleviate symptoms of depression, but the effect of less strenuous activities was unclear.
A study in the journal Mental Health and Physical Activity showed walking had a “large effect” on depression.
One in 10 people may have depression at some point in their lives.
The condition can be treated with drugs, but exercise is commonly prescribed by doctors for mild symptoms.
Researchers at the University of Stirling scoured academic studies to find data on one of the mildest forms of exercise – walking.
They found eight studies, on a total of 341 patients, which fitted the bill.
The report’s authors showed “walking was an effective intervention for depression” and had an effect similar to other more vigorous forms of exercise.
Walking could play an important role in fighting depression, according to researchers in Scotland
They said: “Walking has the advantages of being easily undertaken by most people, incurring little or no financial cost and being relatively easy to incorporate into daily living.”
However, they cautioned that much more research needed to be done. There are still questions over how long, how fast and whether walking should take place indoors or outdoors.
Prof. Adrian Taylor, who studies the effects of exercise on depression, addiction and stress at the University of Exeter, said: “The beauty of walking is that everybody does it.”
He added: “There are benefits for a mental-health condition like depression.”
How any form of exercise helps with depression is unclear. Prof. Adrian Taylor said there were ideas about exercise being a distraction from worries, giving a sense of control and releasing “feel-good” hormones.
The mental-health charity Mind said its own research found that spending time outdoors helped people’s mental health.
Its chief executive, Paul Farmer, said: “To get the most from outdoor activities it’s important to find a type of exercise you love and can stick at. Try different things, be it walking, cycling, gardening or even open-water swimming.
“Exercising with others can have even greater impact, as it provides an opportunity to strengthen social networks, talk through problems with others or simply laugh and enjoy a break from family and work. So ask a friend to join you.”
