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Talking therapy can help depression if drugs haven't helped

By Kathy Oxtoby

People with depression that isn’t helped by drugs are more likely to get better if they receive a type of treatment called cognitive behavioural therapy (CBT), a large study suggests.

What do we know already?

About 1 in 7 adults get depression serious enough to need treating at some point in their lives. Antidepressant drugs help people with severe depression, but research shows they don’t seem to help much with milder depression. Even when antidepressants do help, many people get depressed again in the future.

Another treatment designed to help ease symptoms of depression is cognitive behaviour therapy (CBT). This is a kind of talking treatment (psychotherapy) that aims to teach people how to cope better with symptoms of depression, and how to avoid unhelpful patterns of thought and behaviour.

The aim of CBT is to help you think and behave more positively, and research shows that if you have mild or moderate depression, this treatment can help.

So far, there has been little evidence to show that CBT can help people who have already tried antidepressants that haven’t helped them. Now a study has looked at whether people taking antidepressants together with CBT are more likely to get better than those who only take drug treatments.

The study involved 469 adults who had already had at least six weeks of treatment with an antidepressant. People who took part in the study either continued with the antidepressant medication provided by their GP, or they received up to 18 sessions of CBT as well as their usual care. These patients were then followed up six and 12 months later to find out if taking CBT along with taking antidepressants and their usual care made a difference and helped ease their symptoms of depression.

What does the new study say?

Researchers found that people with depression who have already tried drug treatments are three times more likely to get better if they have CBT in addition to antidepressants and usual care.

After six months, nearly half (46 in 100) of those people who received CBT in addition to antidepressants and their usual care felt an improvement in their symptoms. This compared to 22 in 100 people who continued with their usual treatments. Researchers also found that those who had this combined treatment still had fewer symptoms after 12 months.

How reliable is the research?

This is a large and good-quality study, carried out over a longer period than previous research, which means its results should be reliable.

However, there are also many other factors that may have resulted in people feeling less depressed, which may have affected the study’s results. The study did not include women who were pregnant - who may be at risk of post-natal depression - or those with complex conditions, such as bipolar disorder or alcohol and substance abuse problems. So the study does not show whether the many different groups of people who are depressed might benefit from having CBT while taking drug treatments.

The study also only included people taking these combined treatments over a 12 month period, so it is not clear whether CBT might benefit people with depression who take antidepressants for longer.

What does this mean for me?

CBT may be an option if you are feeling depressed and your antidepressants don’t seem to be working.

But CBT is difficult to access, despite efforts from the NHS to make talking treatments more widely available. It’s not always easy to get an appointment with a trained therapist and you may face a long waiting list. So it’s best to talk to your doctor.


Wiles N, Thomas L, Abel A, et al. Cognitive behavioural therapy as an adjunct to pharmacotherapy for primary care based patients with treatment resistant depression: results of the CoBalT randomised controlled trial. Lancet. Published online 7 December 2012.

Dec 11, 2012