CBT added to antidepressant drugs was beneficial in primary care practices.

Primary care physicians (PCPs) often prescribe antidepressant medications, but only about a third of patients will respond fully to initial pharmacotherapy. When initial pharmacotherapy fails, options include dose escalation, changing agents, or psychotherapy. Brief cognitive-behavioral therapy (CBT) is effective for patients with previously untreated depression, but its role as second-line therapy, added to antidepressant medications, has not been studied well.

Researchers in the U.K. identified 469 depressed adults who had failed to respond to a minimum of 6 weeks of antidepressant therapy. Patients continued to receive usual care by their PCPs (including antidepressants) and were randomized to receive or to not receive 12 to 18 sessions of CBT delivered in or near their PCPs’ offices. Usual-care participants could be referred for counseling, CBT, or secondary care, when such treatment was deemed to be clinically appropriate.

After 6 months, significantly more patients in the CBT group than in the usual care–alone group (46% vs. 22%) reached the primary endpoint of 50% decline in depressive symptoms, as measured by the 63-point Beck Depression Inventory (BDI). Patients who received CBT also had significantly higher rates of remission (BDI <10) after 6 months. Differences in these outcomes remained significant after 12 months of follow-up.

Comment: This study will support the growing interest in integrating behavioral health services into primary care practices, where psychiatric and somatic morbidities commonly coexist and interact. New clinical and financial models will be required, but the payoff for patients’ health and productivity could be substantial.

Source:Journal Watch General Medicine