resistant depression and cognitive behavioral therapy

article in the lancet on patients with treatment resistant depression. (see depression resistant and CBT lancet 2013 in dropbox). 469 pts aged 18-75 on antidepressants for >6 weeks but with persistent depression (Beck depression inventory BDI score >=14) in the UK.  randomized to usual care (without any restrictions on treatment options) vs adding cognitive behavioral therapy (twelve 50-60 minute sessions) to usual care. primary outcome was response with at least 50% decrease in depressive symptoms at 6 months compared to baseline. baseline BDI score was 32 (severe depression is 29-63).
 
results:
    -- 90% were followed up to 6 months, 84% for  a year
    -- 46% of the usual care plus CBT vs 22% in the usual care group met criteria for response at 6 months. 55% vs 31% at 12 months.  93% of both groups were taking antidepressant meds at 6 months, 88% of the CBT and 92% of the usual care were at 12 months.
    -- full remission rates (BDI <10) in 28% vs 15% after 6 months, 40% vs 18% at 12 months.
 
this is the largest study of its kind using CBT.  the STAR*D study was limited since only 26% of their non-response group were willing to be randomized to CBT.  this study is consistent with other depression studies suggesting added benefit of combo of meds and therapy

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