Quality Measures Database

The treatment of mental or emotional problems using psychological techniques (e.g., cognitive behavioural therapy, or talking therapy).
Additional Domain(s) : Patients with Mood Disorders, Continuity

In the only comparison available from a single trial there was insufficient evidence to determine the efficacy of individual CBT for depression compared to either pill placebo (plus clinical management) or other psychotherapies.
However, stronger data do exist when CBT is compared with antidepressants (a number of which include clinical management); here individual CBT is as effective as antidepressants in reducing depression symptoms by the end of treatment. These effects are maintained a year after treatment in those treated with CBT whereas this may not be the case in those treated with antidepressants. CBT appears to be better tolerated than antidepressants, particularly in patients with severe to very severe depression. There is a trend suggesting that CBT is more effective than antidepressants on achieving remission in moderate depression, but not for severe depression. There was also evidence of greater maintenance of a benefit of treatment for CBT compared with antidepressants. We recognize that this is a different finding to that of Elkin et al (1989).
Adding CBT to antidepressants is more effective than treatment with antidepressants alone, particularly in those with severe symptoms. (This is the subject of a cost-effectiveness analysis in Chapter 9.) There is no evidence that adding an antidepressant to CBT is generally helpful, although we have not explored effects on specific symptoms (e.g., sleep). There is insufficient evidence to assess the effect of CBT plus antidepressants on relapse rates.
There is evidence from one large trial (Keller et al, 2000) for chronic depression that a combination of CBT and antidepressants is more beneficial in terms of remission than either CBT or antidepressants alone. In residual depression the addition of CBT may also improve outcomes.
It appears to be worthwhile adding CBT to antidepressants compared with antidepressants alone for patients with residual depression as this reduces relapse rates at follow-up, although the advantage is not apparent post-treatment.
In regard to modes of delivery there is evidence that group CBT is more effective than other group therapies, but little data on how group CBT fares in comparison with individual CBT. Much may depend on patient preferences for different modes of therapy. However, group mindfulness-based CBT appears to be effective in maintaining response in people who have recovered from depression, particularly in those who have had more than two previous episodes.

Depression-Management of depression in primary and secondary care. Clinical Guideline 23.NICE. December 2004. Section 6.11.1.7; p: 171. Retrieved on Aug 3, 2006 from: http://www.nice.org.uk/page.aspx?o=cg023niceguideline

II: Less rigorous studies specifically focused on primary mental health care or extrapolated from higher quality studies from secondary mental health care.

• * Regrettably, follow up is often based on resources rather than the individual's needs.
• There seems to be a presumption that there are endless mental health and primary care resources - there are barely enough for moderate to severe mental health issues.
• There is evidence that young therapists can be of more help to certain patients e.g. AXIS II because they are less jaded

Ratings-based Rank Relevance 50 Actionability 53 Overall Importance 72		Stakeholder Rank Academics 84 Clinicians 47 Consumers 39 Decision Makers 55 �		Special Group Rank First Nations 92 Rural Areas 55 Federal Stakeholders 53
Regional Rank BC AB SK MB ON QC NB NS PE NL YT NT NU 78 86 104 75 58 32 63 70 52 114 69 89 105				Overall Rank        56