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Adjunctive CBT increases response in pharmacotherapy-resistant depression in primary care

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Question: How effective is adding cognitive behavioural therapy (CBT) to pharmacotherapy-based usual care for primary care patients with treatment resistant depression?

Patients: A total of 469 adults (average age 49.6 years, 72% female and 44% in paid employment) with treatment resistant depression (meeting ICD-10 criteria for depression, treated with adequate dose of antidepressants for ≥6 weeks but still with Beck depression inventory (BDI) score ≥14). For more than half of the participants (59%) the current depression episode had lasted 2 years or longer, and 70% had taken their antidepressant for over a year. People with bipolar disorder, psychotic disorder, or major alcohol or substance abuse problems were excluded, as were pregnant women, those unable to complete study questionnaires, those currently receiving CBT, other psychotherapy or secondary care for depression, or those who had received CBT in the past 3 years.

Setting: A total of 73 general practices in Bristol, Exeter and Glasgow, UK; 2008–2011.

Intervention: CBT plus usual care or usual care alone. CBT was provided as 12 individual sessions of 50–60 min, with …

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  • Sources of funding: National Institute for Health Research Health Technology Assessment.


  • Competing interests None.

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