Abstract
Background: How to treat Major Depressive Disorder (MDD) in primary care? Studies that compared (brief) Cognitive Behavioural Therapy (CBT) with care as usual by the General Practitioner (GP) found the first to be more effective. However, to make a fair comparison GP care should be optimised and protocolised according to current evidence based guidelines for depression. So far this has not been the case. We studied whether a protocolised 8 session CBT is more effective than optimised and protocolised GP care (GPC). Methods: 121 patients with MDD, age 18-70 years, from 40 Dutch general practices, were randomised to either brief CBT or GPC. Assessments were at baseline (t0), 12 weeks (t1) and 52 weeks (t2). Main outcomes: decrease in depressive symptoms, response and remission on the Hamilton Depression Rating Scale-17 (HDRS-17) and the Patient Health Questionnaire-9 (PHQ-9). (Trial registration: ISRCTN65811640). Results: Both continuous and dichotomous HDRS-17 and PHQ-9 outcome scores favoured the brief CBT group. Number of treatment contacts and external referrals were not different between groups. GPs prescribed antidepressants (AD) to 48% of GPC patients and to 11% of CBT patients. Conclusions: Brief CBT by psychologists seems more effective than optimized GPC. Effect sizes comparable to the (statistical significant) results from meta-analyses, together with lower AD prescriptions, are both in favour of brief CBT which might make it a first choice treatment for patients with MDD in general practice.
Highlights
Major Depressive Disorder (MDD) is a heterogeneous illness with quite different levels of severity and duration, varying numbers of recurrences over the life-time and a ten percent risk for a chronic course
Brief Cognitive Behavioural Therapy (CBT) by psychologists seems more effective than optimized general practitioners’ care (GPC)
Effect sizes comparable to the results from meta-analyses, together with lower AD prescriptions, are both in favour of brief CBT which might make it a first choice treatment for patients with MDD in general practice
Summary
Major Depressive Disorder (MDD) is a heterogeneous illness with quite different levels of severity and duration, varying numbers of recurrences over the life-time and a ten percent risk for a chronic course. The one year prevalence rates range from 4% to 8% in the general population [1,2,3] and raise to 12% to 25% among primary care (PC) populations across the world [4]. Related to this heterogeneity, treatment of MDD differs widely in terms of method, intensity, duration, setting and professional(s). To make a fair comparison GP care should be optimised and protocolised according to current evidence based guidelines for depression. We studied whether a protocolised 8 session CBT is more effective than optimised and protocolised GP care (GPC)
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