Psychological therapies for adults with treatment-resistant depression

Depression is a common problem in adults and is often treated with antidepressants. However, many people who take antidepressants don’t get better. This is known as treatment-resistant depression. For these people, there are a few different treatment options, including increasing the dose of the antidepressant they’ve been prescribed, adding another medication, or switching to a new one.

Another option is to add or switch to psychotherapy, also known as talking therapy. There is already evidence that psychotherapies can help people with depression.

Project aims

We didn’t know if psychotherapies work for people with treatment-resistant depression. This review aimed to answer this question.

What we did

To find all studies on this topic we searched several lists of scientific studies and contacted experts in the field. Two researchers independently assessed each study to decide whether it was relevant and if so, to include it in our review. We then pooled the results of all the relevant studies.

We ended up analysing six randomised trials, which can give us the best evidence about whether a treatment is of benefit. In these studies, participants are allocated at random to receive one of the treatments being compared.

What we found and what this means

The trials included 698 people in total and tested three types of psychotherapy. They all looked at whether adding psychotherapy to existing antidepressant treatment led to improvements, and if the psychotherapy treatment was acceptable to patients. All the studies were funded by public research grants.

Patients who received psychotherapy on top of usual care with antidepressants had fewer depressive symptoms. They were twice as likely to be depression free in six months compared with patients who continued with usual care – taking antidepressants – alone.

Because of the size and quality of the studies we reviewed, we are moderately confident in these findings. The true effect of adding psychotherapies may be different from what we found, although it’s likely to be close to it. We also found that adding psychotherapy on top of taking antidepressants was as acceptable to patients as usual care alone.

Similar beneficial effects were seen in two studies after 12 months and in one study at 46 months. Because participants were aware of the treatment they had received, and the number of studies was small, we graded the evidence as moderate quality for findings at six months, and low quality for long-term results. This might change in the future if higher quality research becomes available.

Two studies reported harmful effects in people receiving usual care alone (one suicide and two people were hospitalised) but no harmful event was seen in people who received psychotherapy in addition to usual care.

What next?

These results suggest that psychotherapy should be offered in addition to usual care to people with treatment-resistant depression.

We still don’t know if there are any differences between types of psychotherapy. We also need to know if switching to a psychotherapy is better than staying on antidepressants. Future studies need to answer these important questions.

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Lead collaborators

Partners on this project

University of Bristol

The University of Bristol is internationally renowned and one of the very best in the UK, due to its outstanding teaching and research, its superb facilities and highly talented students and staff. Its students thrive in a rich academic environment which is informed by world-leading research. It hosts the Elizabeth Blackwell Institute for Health Research.