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Should Cognitive Behavioural Therapy (not antidepressant drugs) be the first-line treatment for depression?

CBT_brain

Depres­sion: A change of mind (Nature):

Cog­ni­tive ther­a­py, com­mon­ly known as cog­ni­tive behav­iour­al ther­a­py (CBT), aims to help peo­ple to iden­ti­fy and change neg­a­tive, self-destruc­tive thought pat­terns. And although it does not work for every­one with depres­sion, data have been accu­mu­lat­ing in its favour. “CBT is one of the clear suc­cess sto­ries in psy­chother­a­py,” says Ste­fan Hof­mann, a psy­chol­o­gist at Boston Uni­ver­si­ty in Mass­a­chu­setts…

Anti­de­pres­sant drugs are usu­al­ly the first-line treat­ment for depres­sion.

They are seen as a quick, inex­pen­sive fix — but clin­i­cal tri­als reveal that only 22–40% of patients emerge from depres­sion with drugs alone. Although there are var­i­ous approach­es to psy­chother­a­py, CBT is the most wide­ly stud­ied; a meta-analy­sis1 pub­lished this year revealed that, depend­ing on how sci­en­tists mea­sure out­comes, between 42% and 66% of patients no longer meet the cri­te­ria for depres­sion after ther­a­py…

Peo­ple with depres­sion tend to have detectable dif­fer­ences in two pri­ma­ry brain sys­tems: the pre­frontal cor­tex, which is respon­si­ble for com­plex men­tal tasks such as self-con­trol and plan­ning, and the lim­bic sys­tem — includ­ing the amyg­dala — which is involved in emo­tion­al pro­cess­ing. In healthy peo­ple, the pre­frontal cor­tex can inhib­it amyg­dala activ­i­ty, keep­ing emo­tions in check. But imag­ing shows that in many peo­ple with depres­sion, the pre­frontal cor­tex seems to be less active. “Depressed peo­ple have what you might think of as a trig­ger-hap­py amyg­dala,” says Greg Siegle, a neu­ro­sci­en­tist at the Uni­ver­si­ty of Pitts­burgh in Pennsylvania…“Cognitive ther­a­py teach­es you to step in and use your pre­frontal cor­tex rather than let­ting your emo­tions run away with you”

Study: The effects of psy­chother­a­pies for major depres­sion in adults on remis­sion, recov­ery and improve­ment: A meta-analy­sis (Jour­nal of Affec­tive Dis­or­ders). From the Abstract:

  • Dis­cus­sion: Psy­chother­a­py con­tributes to improve­ment in depressed patients, but improve­ment in con­trol con­di­tions is also con­sid­er­able.
  • Meth­ods: We con­duct­ed a meta-analy­sis of 92 stud­ies with 181 con­di­tions (134 psy­chother­a­py and 47 con­trol con­di­tions) with 6937 patients meet­ing cri­te­ria for major depres­sive dis­or­der…
  • Results: After treat­ment, 62% of patients no longer met cri­te­ria for MDD in the psy­chother­a­py con­di­tions. How­ev­er, 43% of par­tic­i­pants in the con­trol con­di­tions and 48% of peo­ple in the care-as-usu­al con­di­tions no longer met cri­te­ria for MDD, sug­gest­ing that the addi­tion­al val­ue of psy­chother­a­py com­pared to care-as-usu­al would be 14%. For response and remis­sion, com­pa­ra­ble results were found, with less than half of the patients meet­ing cri­te­ria for response and remis­sion after psy­chother­a­py…

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