Four studies published recently in depression and bipolar disorder suggest some different and unique benefits of psychotherapy. This is a long entry, so you’ll have to “read more” to get the full story.
Treatment Resistance in Depression
Lekin and associates examined 240 patients with moderate-to-severe major depressive disorder to see how cognitive therapy helps in people who have tried various types of antidepressant medications (without relief from their depression):
Recent research suggests that there may be a reduction in therapeutic response after multiple administrations of antidepressant drug (AD) therapy in patients with major depressive disorder. This study assessed the response to AD therapy and cognitive therapy (CT) of patients with a history of prior AD exposures.
The subjects in the study entered a randomized controlled trial comparing pharmacotherapy with paroxetine (Paxil) to cognitive therapy and treatment was administered for 16 weeks. Although this study only looked at Paxil, the researchers found that more prior antidepressant medication exposures predicted a poor response to treatment with Paxil, but not to cognitive therapy.
If these findings are replicated in methodologically rigorous studies of paroxetine and other antidepressants, cognitive therapy should be recommended, in preference to antidepressant medications, for patients [who’ve tried multiple, different antidepressants in the past].
This is consistent with the STAR*D findings, that it takes multiple trials with different antidepressants in order to find effective results in most people. This new study suggests cognitive therapy is, possibly, an even more effective treatment option to pursue.
Telephone-based Cognitive Behavioral Therapy in Primary Care
What if you took a time-tested treatment, cognitive-behavioral therapy, and transplanted it into a new setting (your doctor’s office) and a new modality (by telephone)? Would it still be able to help people with depression?
Well, Lund and his colleagues did exactly that with 393 people, to evaluate the effective of telephone-based cognitive-behavioral therapy, versus usual care for people taking an antidepressant in a primary care setting (e.g., your family doctor’s office). They found that adding a brief, structured cognitive-behavioral therapy program — administered by the telephone! — can significantly improve clinical outcomes for these people with depression. Easy, well-understood, and effective. I hope docs take note.
Intensive Psychotherapy More Effective Than Brief Treatment
Clinicians often suspect that longer-term, intensive psychotherapeutic interventions are more effective than brief, psychoeducational interventions. Research by Miklowitz and friends suggest that the suspicion is true and furthermore, that the actual specific type of intensive psychotherapy (family-focused, interpersonal, or cognitive-behavioral) didn’t matter:
Intensive psychosocial treatment as an adjunct to pharmacotherapy was more beneficial than brief treatment in enhancing stabilization from bipolar depression.
What this basically means that if you have bipolar disorder, and are just in medication management appointments or tried a brief treatment, you’re not doing as well as if you were also in regular psychotherapy too.
Long-term Protection Against Depression
People with depression often experience a frustrating fall back into depression months or even years after their initial episode, due to life events, stress, or other factors. People who experience this decline often find themselves back to taking medications. But what if psychotherapy provided some protection (or “resiliency”) in grappling with future episodes of depression?
Turns out, psychotherapy does just that.
Hawley and his associates looked at 153 people enrolled in an outpatient setting to assess long-term effectiveness of treatments:
Results supported a stress reactivity model in that stressful events led to elevations in the rate of depression change. Furthermore, […] this longitudinal stress reactivity occurred only for outpatients in the medication conditions. Results demonstrate that the enduring impact of psychotherapy involves the development of enhanced resiliency to stressful life events.
So there you have it. Another study showing that psychotherapy, but not medication, provides an enduring effect by reducing depressive vulnerability following the end of treatment.
References
Hawley LL, Ringo Ho MH, Zuroff DC, Blatt SJ. (2007). Stress reactivity following brief treatment for depression: differential effects of psychotherapy and medication. J Consult Clin Psychol. 2007 Apr;75(2):244-56.
Leykin Y, Amsterdam JD, DeRubeis RJ, Gallop R, Shelton RC, Hollon SD. (2007). Progressive resistance to a selective serotonin reuptake inhibitor but not to cognitive therapy in the treatment of major depression. J Consult Clin Psychol. 2007 Apr;75(2):267-76.
Ludman EJ, Simon GE, Tutty S, Von Korff M. (2007). A randomized trial of telephone psychotherapy and pharmacotherapy for depression: continuation and durability of effects. J Consult Clin Psychol. 2007 Apr;75(2):257-66.
Miklowitz DJ, Otto MW, Frank E, Reilly-Harrington NA, Wisniewski SR, Kogan JN, Nierenberg AA, Calabrese JR, Marangell LB, Gyulai L, Araga M, Gonzalez JM, Shirley ER, Thase ME, Sachs GS. (2007). Psychosocial treatments for bipolar depression: a 1-year randomized trial from the Systematic Treatment Enhancement Program. Arch Gen Psychiatry. 2007 Apr;64(4):419-26.
3 comments
As someone who has been diagnosed with Bipolar Disorder, Borderline Personality Disorder, and ADHD (to name just a few!), I had found myself “treatment resistant”, with nowhere to go. I had tried just about every psych med out there, and many, many drug cocktails over an 8 year period. Nothing worked. Nothing, that is, until I went into intensive psychotherapy, with an awesome therapist.
As it is now, I’ve been in therapy (client centered therapy) for 9 months, on a weekly basis, and I have discovered that I am NOT “mentally ill”, nor have I EVER been. The so-called “mental illness” that I had, turned out to be a NORMAL reaction to a very “messed up” childhood (trauma, etc.) Unfortunately, I had fallen into the mental illness trap — the one that says “You have a chemical imbalance, there is something pathologically wrong with your brain, your personality is ‘disordered,’ and you’ll pretty much never recover. (Although, you can ‘manage’ your ‘illness’ with a bunch of mind numbing meds…)”
I believed that load of, ahem…”stuff” for many years, I embraced it, even. Why not, when I had no HOPE to cling to? Therapy is so underrated, when it should be, in my opinion, the first line of treatment, not the last. That is not to say that some people do not benefit from taking psych meds (I know some people need them), but in my case, the meds did nothing but hinder my recovery.
If someone is seeking relief from “psychiatric problems”, the first thing they need to do is find a GOOD therapist who will help them work through all the problems they have…find someone who will stop pathologizing them, and get on with figuring out where the problems stemmed from in the first place.
Recovery IS possible through intensive psychotherapy.
I too discovered this on my own by trial and error. I took AD’s and continued to feel depressed, so I finally decided there was no point in taking AD’s and after 10+ years wanted to know what I was like without them, so I stopped taking them 2 years ago. I have recently started psychotherapy as my treatment of choice and because I have researched and found therapy to be where the optimism of change and hope exists.
AD’s made me emotionally numb.
Therapy makes me feel alive and moving forward.
Some people can do well with therapy & not meds. That’s wonderful. But I want to mention that studies have shown that repeated, severe trauma in childhood can permanently mess up brain chemistry, so some people will indeed need to take meds long-term, even if the primary problem is ‘simply’ depression, anxiety, whatever, that’s trauma-derived. If one needs it, one needs it, and there’s no shame in it. Either way I just don’t want anyone to feel stigmatized.
Personally, I never had much success with ADs, either. Nor am I having much success with the mood stabilizers I’ve tried. I can’t afford to see a therapist more than a couple of times a month (on good months, financially). I think it would help me much more to have more frequent visits. Recently it’s come to my attention that I may have Asperger’s Syndrome, and if that’s the case, the bipolar diagnosis may have been a misdiagnosis, though my depression & anxiety still need to continue to be addressed. But I understand a lot more about myself, now.