For Depression, Get Intense Psychotherapy, if You Can

Robert W. Griffith, MD

The effectiveness of psychotherapy is not a usual subject of clinical trials. All too often, the treatment of depression revolves around which antidepressant to use - the one with the shortest onset of action, or the one with fewer adverse effects. A new German study published in the American Journal of Psychiatry compares intense one-on-one psychotherapy with 'usual clinical management' in 124 patients with severe depression. The patients were severe enough to be referred for hospitalization (16 or more points on the Hamilton Depression Rating Scale).

The intense psychotherapy consisted of three 50-minute one-on-one sessions weekly for 5 weeks, plus 8 group sessions. 'Clinical management' comprised one 20- to 25-minute session of psychoeducative, supportive, or empathetic intervention weekly for 3 weeks. All patients received medication with sertraline (Zoloft®) or amitriptyline (Elavil®).

The intensive psychotherapy patients had, on average, a greater response at 5 weeks (70% vs. 51%), a sustained response at 12 months (69% vs. 36%), and fewer relapses at 3 months (2.6% vs. 25%) and 12 months (13% vs. 29%).

These findings are extremely impressive. The problem, of course, is the expense. Some well-conducted cost-efficacy studies will be needed to convince health providers that 15 hours of individual professional consultation is worth the additional cost, in the long term.

Source
HealthandAge Blog