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Specific psychotherapy more effective for chronic depression

Disorder-specific psychotherapy was moderately more effective than nonspecific therapy for early-onset chronic depression in adults not receiving antidepressants.

“Compared with acute depression, chronic forms are characterized by greater comorbidity and more impaired social function and physical health, as well as more frequent suicide attempts and hospitalizations. Moreover, this patient group benefits less from psychological and pharmaceutical treatment compared with patients with acute episodic depression, or they need higher dosages of medication and a longer duration of treatment to improve,” Elisabeth Schramm, PhD, of University of Freiburg, Germany, and colleagues wrote. “The only specific psychotherapy that has been tailored for early-onset chronic depression is the Cognitive Behavioral Analysis System of Psychotherapy (CBASP), which fared equally well as medication and significantly increased efficacy when added to treatment with antidepressants

To assess efficacy of CBASP vs. non-specific supportive psychotherapy for chronic depression, researchers conducted a randomized clinical trial among 268 adults with early-onset chronic depression who were not receiving antidepressants. Study participants were randomly assigned to receive 24 sessions of CBASP (n = 137) or supportive psychotherapy (n = 131) for 20 weeks followed by eight continuation sessions during the next 28 weeks.

Mean baseline Hamilton Rating Scale for Depression (HAM-D) scores improved from 27.15 to 17.19 in the CBASP group and 27.05 to 20.39 in the supportive psychotherapy group.

After 20 weeks, there was a significant adjusted mean difference of –2.51 (95% CI, –4.16 to –0.86; P = .003), favoring CBASP.

At 48 weeks, mean HAM-D scores were 14 for the CBASP group and 16.49 for the supportive psychotherapy group, with an adjusted difference of –3.13 (95% CI, –5.01 to –1.25; P = .001).

Participants who received CBASP were more likely to achieve response (38.7% vs. 24.3%; adjusted OR = 2.02; 95% CI, 1.09-3.73; P = .03) and remission (21.8% vs. 12.6%; aOR = 3.55; 95% ci, 1.61-7.85; P = .002).

Further, CBASP was favored for most secondary outcomes, according to researchers.

“Perhaps the most important result of this study is that it confirms what has been found in earlier, smaller trials; namely, that patients with chronic depression can improve,” Pim Cuijpers, PhD, of Vrije Universiteit Amsterdam, and colleagues wrote in an accompanying editorial. “The response rates are overall somewhat lower than in patients with nonchronic depressive disorders after treatment with pharmacotherapy or with psychotherapy, but not very much. That is encouraging news for patients and clinicians.” – by Amanda Oldt

Disclosure: Schramm reports receiving book royalties and honoraria for workshops and presentations relating to the Cognitive Behavioral Analysis System of Psychotherapy (CBASP). Please see the study for a full list of relevant financial disclosures.