Prevention of Relapse Following Cognitive Therapy vs Medications in Moderate to Severe Depression

Hollon, Steven D.; DeRubeis, Robert J.; Shelton, Richard C.; Amsterdam, Jay D.; Salomon, Ronald M.; O’Reardon, John P.; Lovett, Margaret L.; Young, Paula R.; Haman, Kirsten; Freeman, Brent B.; Gallop, Robert

doi:10.1001/archpsyc.62.4.417

Cited by 636 publications

(483 citation statements)

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“…Several different psychotherapies have been shown to be as efficacious as ADM when adequately implemented. CT was comparable with ADM and each superior to pillplacebo in the reduction of acute distress in two trials, one in a sample of patients with more severe depressions (DeRubeis et al 2005) and the other in a sample of patients with atypical depressions (Jarrett et al 1999), whereas ADM was superior to CT of questionable quality with more severe depressions in the two trials noted above (Elkin et al 1989;Dimidjian et al 2006). BA was comparable with ADM and each superior to pill-placebo among patients with more severe depressions with no differences among patients with less severe depressions in the Seattle study (Dimidjian et al 2006).…”

Section: Must Interventions Be Competently Implemented To Generate a mentioning

confidence: 96%

“…In the Seattle trial, only off-site supervision was available (often with a week or more delay) to the somewhat less experienced CT therapists, whereas supervision was available on-site and without delay to the BA therapists, including the lead author on the original manual (Martell et al 2001). No such concerns have been raised about the adequacy of the CT provided at the University of Pennsylvania site in the study by DeRubeis et al (2005). That was where CT was first developed and the therapists at that site were particularly competent in its implementation, much as was the case for the BA therapists in the Seattle study.…”

Section: Must Interventions Be Competently Implemented To Generate a mentioning

confidence: 99%

“…Both ADM and behavioural activation (BA) showed the same pattern in a trial conducted in Seattle; superior to pill-placebo among patients with more severe depressions, but not separating from pill-placebo among patients who were less severe (Dimidjian et al 2006). Cognitive therapy (CT) was comparable with ADM and both superior to pillplacebo in a study restricted solely to patients with more severe depressions (DeRubeis et al 2005). The basic point is that specificity is sometimes evident, but only among patients with more severe depressions.…”

Section: Is Treatment As Efficacious As Is Currently Believed?mentioning

confidence: 99%

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The efficacy and acceptability of psychological interventions for depression: where we are now and where we are going

Hollon

2015

Epidemiol Psychiatr Sci

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Depression is an eminently treatable disorder, although estimates of treatment efficacy have been inflated by publication bias. Patients with less severe depressions respond to even nonspecific interventions, whereas patients with more severe depressions require treatments that mobilize specific mechanisms. The cognitive and behavior therapies can be as efficacious as medications in the treatment of severe depression and have an enduring effect that medications lack. Medications may interfere with those enduring effects when added in combination and may prolong the life of the underlying episode when used alone. Thus the cognitive behavioral interventions might be the optimal first-line treatments for depression. First published online 27 August 2015Key words: Depression, precision medicine, prevention, treatment. Is treatment as efficacious as is currently believed?Several different types of interventions have been established in the treatment of major depressive disorder (MDD), but the efficacy of those interventions has been overestimated in the published literature. This appears to be true with respect to both the antidepressant medications (ADMs) and psychotherapy. Turner et al. (2008) found that only half the studies submitted to the Food and Drug Administration to secure marketing approval found active medication to be superior to pill-placebo and that over 90% of those positive studies ended up being published v. only about a third of those with null findings. Moreover, nearly all of the 'failed' studies that did get published were 'spun' to make it appear that ADM was superior to pill-placebo. Correcting for publication bias reduced the estimated effect of medication by about a third. Cuijpers et al. (2010) found comparable magnitude of publication bias in the psychotherapy literature, although this had to be inferred from a relative deficit of small studies with weak effects. What this means is that someone reading the published literature would come away thinking that both ADM and psychotherapy are more efficacious than they really are. It is not that they do not work; just that they do not work as well as the published literature would lead one to believe. Does treatment have a specific effect for less severe patients?Fournier et al. (2010) plotted treatment outcome as a function of initial severity at the level of the individual patient and found that ADM separated from pillplacebo only among patients with more severe depressions. Patients with less severe depressions (over half of the sample) did about as well on pill-placebo as they did on active medications. This means that they are responding to psychological rather than pharmacological mechanisms. Something similar appears to be the case for the psychosocial interventions. Driessen et al. (2010) found that psychosocial interventions only exceeded non-specific controls among patients with more severe depressions. As for medications, this suggests that non-specific factors account for a large portion of the effects of psychotherapy. Cuijpers e...

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Section: Must Interventions Be Competently Implemented To Generate a mentioning

confidence: 96%

Section: Must Interventions Be Competently Implemented To Generate a mentioning

confidence: 99%

Section: Is Treatment As Efficacious As Is Currently Believed?mentioning

confidence: 99%

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The efficacy and acceptability of psychological interventions for depression: where we are now and where we are going

Hollon

2015

Epidemiol Psychiatr Sci

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“…In patients with moderate to severe depression, treatment with the combination of antidepressant medication and CBT can enhance the likelihood of response over either alone, 64 and the benefits of CBT may endure even beyond the end of treatment. 65 …”

Section: Structured Psychotherapymentioning

confidence: 99%

Depression and Cardiovascular Disease

Whooley¹

2006

JAMA

215

160

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Major depressive disorder is a risk factor for the development of incident coronary heart disease events in healthy patients and for adverse cardiovascular outcomes in patients with established heart disease. Depression is present in 1 of 5 outpatients with coronary heart disease and in 1 of 3 outpatients with congestive heart failure, yet the majority of cases are not recognized or appropriately treated. It is not known whether treating depression improves cardiovascular outcomes, but antidepressant treatment with selective serotonin reuptake inhibitors is generally safe, alleviates depression, and improves quality of life. This article evaluates the importance of major depression in patients with cardiovascular disease, and provides practical guidance for identifying and treating this disorder. CASE PRESENTATIONA 58-year-old man with a history of coronary heart disease (CHD), type 2 diabetes mellitus, hypertension, smoking, and alcohol dependence presented for routine medical care. He had initially sought medical attention for exertional angina 5 years previously, at which time he underwent exercise treadmill testing with thallium that was positive for reversible perfusion defects in the anterior, septal, and inferior walls. Subsequent coronary angiography revealed diffuse heavy calcifications in the left anterior descending artery with a moderate lesion prior to the first diagonal. Several major septal perforators had significant lesions at their origins. In the dominant right coronary artery, there were diffuse calcifications but no significant lesions. The left circumflex and large ramus intermedius were free of discrete lesions. Left ventricular function was normal.The patient underwent single-vessel (left internal mammary artery to left anterior descending artery) coronary artery bypass grafting (CABG) surgery. He was prescribed atenolol 100 mg/ d, lisinopril 40 mg/d, lovastatin 80 mg/d, aspirin 325 mg/d, metformin 850 mg 3 times a day, and glipizide 10 mg 2 times a day. Despite being nonadherent to his prescribed medications, he remained stable for 5 years, but then one day, while doing household chores, he suddenly developed chest pressure, shortness of breath, and diaphoresis that lasted 12 hours. On admission to the hospital his troponin I was elevated and peaked at 0.7 ng/mL (normal, <0.05 ng/mL), consistent with a myocardial infarction (MI). His electrocardiogram had not changed.

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“…No large-scale randomised controlled trials (RCTs) 6;7 have evaluated the effectiveness of CBT following non-response to pharmacotherapy compared with continuing pharmacotherapy as part of usual care for patients with TRD..We chose to investigate CBT rather than CBASP as there is evidence that CBT may reduce rates of relapse 11 , including amongst those with residual depressive symptoms 12 .…”

Section: Introductionmentioning

confidence: 99%

Cognitive behavioural therapy as an adjunct to pharmacotherapy for primary care based patients with treatment resistant depression: results of the CoBalT randomised controlled trial

et al. 2013

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Prevention of Relapse Following Cognitive Therapy vs Medications in Moderate to Severe Depression

Abstract: Cognitive therapy has an enduring effect that extends beyond the end of treatment. It seems to be as effective as keeping patients on medication.

Cited by 636 publications

References 21 publications

The efficacy and acceptability of psychological interventions for depression: where we are now and where we are going

The efficacy and acceptability of psychological interventions for depression: where we are now and where we are going

Depression and Cardiovascular Disease

Cognitive behavioural therapy as an adjunct to pharmacotherapy for primary care based patients with treatment resistant depression: results of the CoBalT randomised controlled trial

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