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A Randomized Controlled Trial of Cognitive Behavioural Therapy as an Adjunct to Pharmacotherapy in Primary Care Based Patients with Treatment Resistant Depression: A Pilot Study

Published online by Cambridge University Press:  21 August 2007

Nicola J Wiles ,
Sandra Hollinghurst ,
Victoria Mason ,
Meyrem Musa ,
Victoria Burt ,
Julia Hyde ,
Bill Jerrom ,
Glyn Lewis  and
David Kessler
Nicola J Wiles*
Affiliation:
University of Bristol, UK
Sandra Hollinghurst
Affiliation:
University of Bristol, UK
Victoria Mason
Affiliation:
University of Bristol, UK
Meyrem Musa
Affiliation:
University of Bristol, UK
Victoria Burt
Affiliation:
North Somerset Specialist Drug and Alcohol Service, Weston-Super-Mare, UK
Julia Hyde
Affiliation:
University of Bristol, UK
Bill Jerrom
Affiliation:
Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, UK
Glyn Lewis
Affiliation:
University of Bristol, UK
David Kessler
Affiliation:
University of Bristol, UK
*
Reprint requests to Nicola J. Wiles, Academic Unit of Psychiatry, Department of Community Based Medicine, University of Bristol, Cotham House, Cotham Hill, Bristol BS6 6JL, UK. E-mail: [email protected]
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Abstract

No randomized controlled trials (RCTs) have been conducted of cognitive behavioural therapy (CBT) for depressed patients who have not responded to antidepressants, yet CBT is often reserved for this group. We conducted a pilot study for a pragmatic RCT of the clinical effectiveness of CBT as an adjunct to pharmacotherapy in primary care based patients with treatment resistant depression (TRD). Patients on antidepressants for at least 6 weeks were mailed a study invitation by their GP. Those who consented to contact were mailed a questionnaire. TRD was defined as compliance with medication (self-report) and Beck Depression Inventory (BDI) ≥ 15. Those who met ICD-10 depression criteria were eligible for randomization and followed after 4 months. Of 440 patients mailed, 65% responded and 72% consented to contact. Ninety-four percent completed the questionnaire and 82 patients (42%) had TRD. Thirty were subsequently identified as ineligible and 10 did not participate further. Twenty-six of the remaining 42 patients met ICD-10 depression criteria and 25 agreed to being randomized. Twenty-three patients completed the 4-month follow-up questionnaire. Recruitment into a RCT to examine the effectiveness of CBT as an adjunct to pharmacotherapy in primary care based patients with TRD appears feasible and should now be conducted.

Keywords

CBTtreatment resistancedepressionprimary care
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 36 , Issue 1 , January 2008 , pp. 21 - 33
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2007

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References

Beck, A., Steer, R. A. and Brown, G. K. (1996). Beck Depression Inventory Manual (2nd ed.). San Antonio: The Psychological Corporation.Google Scholar
Beck, A., Ward, C., Mendelson, M., Mock, J. and Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.CrossRefGoogle ScholarPubMed
Beck, J. (1996). Cognitive Therapy: basics and beyond. New York: Guilford Press.Google Scholar
Blackburn, I.-M., James, I. A., Milne, D. L., Baker, C., Standart, S., Garland, A. and Reichelt, F. K. (2001). The revised cognitive therapy scale (CTS-R): psychometric properties. Behavioural and Cognitive-Psychotherapy, 29, 431–446.CrossRefGoogle Scholar
Brown, S., Thorpe, H., Hawkins, K. and Brown, J. (2005). Minimization: reducing predictability for multi-centre trials whilst retaining balance within centre. Statistics in Medicine, 24, 3715–3727.CrossRefGoogle ScholarPubMed
Brugha, T. S., Sturt, E., MacCarthy, B., Potter, J., Wykes, T. and Bebbington, P. E. (1987). The Interview Measure of Social Relationships: the description and evaluation of a survey instrument for assessing personal social resources. Social Psychiatry, 22, 123–128.CrossRefGoogle ScholarPubMed
Brugha, T. S., Wing, J. K., Brewin, C. R., MacCarthy, B. and Lesage, A. (1993). The relationship of social network deficits with deficits in social functioning in long-term psychiatric disorders. Social Psychiatry and Psychiatric Epidemiology, 28, 218–224.CrossRefGoogle ScholarPubMed
Clark, R. E., Ricketts, S. K. and McHugo, G. J. (1996). Measuring hospital use without claims: a comparison of patient and provider reports. Health Services Research, 31, 153–169.Google ScholarPubMed
Department of Health (2006). End of the “Prozac Nation”: more counselling, more therapy, less medication to treat depression. http://www.dh.gov.uk/PublicationsAndStatistics/PressReleases/PressReleasesNotices/fs/en?CONTENT_ID=4134785&chk=HKLLdo (accessed 12 May 2006)Google Scholar
Ewing, G., Rogers, M., Barclay, S., McCabe, J., Martin, A. and Todd, C. (2004). Recruiting patients into a primary care based study of palliative care: why is it so difficult? Palliative Medicine, 18, 452–459.CrossRefGoogle ScholarPubMed
Fava, M. (2005). Diagnosis and definition of treatment-resistant depression. Biological Psychiatry, 53, 649–659.CrossRefGoogle Scholar
George, C. F., Peveler, R. C., Heiliger, S. and Thompson, C. (2000). Compliance with tricyclic antidepressants: the value of four different methods of assessment. British Journal of Clinical Pharmacology, 50, 166–171.CrossRefGoogle ScholarPubMed
Keller, M. B., McCullough, J. P., Klein, D. N., Arnow, B., Dunner, D. L., Gelenberg, A. J., Markowitz, J. C., Nemeroff, C. B., Russell, J. M., Thase, M. E., Trivedi, M. H. and Zajecka, J. (2000). A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. New England Journal of Medicine, 342, 1462–1470.CrossRefGoogle ScholarPubMed
Klaber-Moffett, J., Torgerson, D., Bell-Syer, S., Jackson, D., Llewlyn-Phillips, H., Farrin, A. and Barber, J. (1999). Randomized controlled trial of exercise for low back pain: clinical outcomes, costs, and preferences. British Medical Journal, 319, 279–283.CrossRefGoogle Scholar
Lewis, G. (1994). Assessing psychiatric disorder with a human interviewer or a computer. Journal of Epidemiology and Community Health, 48, 207–210.CrossRefGoogle ScholarPubMed
Lewis, G., Pelosi, A. J., Araya, R. and Dunn, G. (1992). Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers. Psychological Medicine, 22, 465–486.CrossRefGoogle ScholarPubMed
Morisky, D. E., Green, L. W. and Levine, D. M. (1986). Concurrent and predictive validity of a self-reported measure of medication adherence. Medical Care, 24, 67–74.CrossRefGoogle ScholarPubMed
National Institute for Clinical Excellence (2004). Clinical Guideline 23. Depression: management of depression in primary and secondary care. London: National Institute for Clinical Excellence.Google Scholar
Pampallona, S., Bollini, P., Tibaldi, G., Kupelnick, B. and Munizza, C. (2004). Combined pharmacotherapy and psychological treatment for depression. Archives of General Psychiatry, 61, 714–719.CrossRefGoogle ScholarPubMed
Patel, A., Rendu, A., Moran, P., Leese, M., Mann, A. and Knapp, M. (2005). A comparison of two methods of collecting economic data in primary care. Family Practice, 22, 323–327.CrossRefGoogle ScholarPubMed
Paykel, E. S., Scott, J., Teasdale, J. D., Johnson, A. L., Garland, A., Moore, R., Jenaway, A., Cornwall, P. L., Hayhurst, H., Abbott, R. and Pope, M. (1999). Prevention of relapse in residual depression by cognitive therapy: a controlled trial. Archives of General Psychiatry, 56, 829–835.CrossRefGoogle ScholarPubMed
Singleton, N., Meltzer, H., Gatward, R., Coid, J. and Deasy, D. (1998). Psychiatric Morbidity Among Prisoners in England and Wales. London: TSO.Google Scholar
Souery, D. A., Amsterdam, J., de Montigny, C., Lecrubier, Y., Montgomery, S., Lipp, O., Racagni, G., Zohar, J. and Mendlewicz, J. (1999). Treatment resistant depression: methodological overviews and operational criteria. European Neuropsychopharmacology, 9, 83–91.CrossRefGoogle ScholarPubMed
Stimpson, N., Agrawal, N. and Lewis, G. (2002). Randomized controlled trials investigating pharmacological and psychological interventions for treatment-refractory depression: systematic review. British Journal of Psychiatry, 181, 284–294.CrossRefGoogle ScholarPubMed
Thase, M. E. and Rush, A. J. (1997). When at first you don't succeed: sequential strategies for antidepressant nonresponders. Journal of Clinical Psychiatry, 58 Suppl 13, 23–29.Google ScholarPubMed
World Health Organization (1992). International Statistical Classification of Diseases and Health Related Problems (10th rev.). Geneva: World Health Organization.Google Scholar
World Psychiatric Association (1974). Symposium on therapy resistant depression. Pharmacopsychiatry, 7, 69–74.Google Scholar
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