Friday, August 22, 2014

New Study: Treating Major Depressive Disorder With Medication And Cognitive Therapy

Logo of the United States National Institute o...
Logo of the United States National Institute of Mental Health, part of the National Institutes of Health. (Photo credit: Wikipedia)

Examining major depressive disorder (MDD)


When a discussion of depression is in the news most people tend to think that there is only one kind of depression. It is those who are diagnosed with depression by mental health experts, and their family members, who learn the difference between major depressive disorder and chronic depression or dysthymia.   

The WebMD® website offers a discussion of the types of depression.
According to the National Institute of Mental Health, major depressive disorder is characterized by a combination of symptoms that interfere with a person's ability to work, sleep, study, eat, and enjoy once-pleasurable activities. There are times you may feel sad, lonely, or hopeless for a few days. But major depression -- clinical depression -- lasts longer and is disabling. It can prevent you from functioning normally. An episode of clinical depression may occur only once in a person's lifetime. More often, though, it recurs throughout a person's life. In addition, with major depression, one of the symptoms must be either depressed mood or loss of interest. The symptoms should be present daily or for most of the day or nearly daily for at least two weeks. Also, the depressive symptoms must cause clinically significant distress or impairment in functioning. The symptoms cannot be due to the direct effects of a substance -- drug abuse, medications -- or a medical condition, such as hypothyroidism, nor occur within two months of the loss of a loved one.
Chronic depression, or dysthymia, is characterized by a long-term (two years or more) depressed mood. There are also symptoms present that are associated with major depression but not enough for a diagnosis of major depression. Chronic depression is less severe than major depression and typically does not disable the person. If you have dysthymia or chronic depression, you may also experience one or more episodes of major depression during your lifetime.

New study examines the rate of recovery for MDD


This week the results of a new study were published online JAMA Psychiatry: Effect of Cognitive Therapy With Antidepressant Medications vs Antidepressants Alone on the Rate of Recovery in Major Depressive Disorder. 

Researchers were from Vanderbilt University, the University of Pennsylvania, the University of New Mexico, the University of Alabama, Rush University and West Chester University. The lead author is Vanderbilt University's Steven D. Hollon, PhD and the study was funded by the National Institute of Mental Health. The team set out to examine if there is a difference in outcome when treating MDD with only antidepressant medication (ADM) vs a treatment that combines medication with cognitive therapy (CT).

Study's parameters


  • The study was a randomized clinical trial conducted at three US university medical centers
  • 452 adults participated in the study
  • Each adult was an outpatient with chronic depression or recurrent major depressive disorder
  • Each adult was assigned to receive either treatment with antidepressants or treatment with  antidepressants combined with cognitive therapy
  • The patients were studied until they reached remission through recovery (defined as six months without symptoms)
  • Some patients were studied for over three years

Study's findings


According to a Medscape article:
  • Results showed that combining CT and ADM significantly improved rates of recovery vs ADM alone, at 72.6% vs 62.5%, respectively.
  • However, the investigators note that the advantage of combined treatment was limited to patients with severe, nonchronic MDD;
  • little benefit was observed for patients with less severe or chronic depression.
  • In addition, the dropout rate in the combined treatment group was lower than in the group that received ADM alone (18.9% vs 26.8%).
  • Further, those receiving combination therapy experienced fewer adverse events than those who received ADMs alone, mainly because they experienced less time in an MDD episode, the investigators note.

Some closing thoughts...


Cottonwood Tucson's staff  provides a multifaceted approach, treating the whole person. Our board certified psychiatrists are skilled at treating clinical depression using non-habit forming medications to gently re-regulate the depressed person’s brain functioning. Individual and group therapy is helpful in identifying behavioral and attitudinal components of clinical depression and can help patients lighten and stabilize their mood and develop more adaptive ways of managing thoughts and feelings that may act as triggers to depressive episodes. We also incorporate Cognitive Behavioral Therapy (CBT) that allows our therapists to help patients identify and challenge unhealthy or irrational beliefs that can cause emotional pain. Grief groups, trauma therapy and Eye Movement Desensitization and Reprocessing (EMDR) can help lessen the emotional resonance of painful memories help patients to explore and process the root causes of their depression.

Research indicates that individuals who continue therapy following inpatient treatment have a higher likelihood of maintaining recovery behavior. Understanding the value of aftercare, Cottonwood treatment places a strong emphasis on developing a comprehensive aftercare plan reflective of each patient's individual needs.

Each discharging patient is provided with continuing care referrals responsive to their needs. These might include: continuing residential care, psychiatric follow-up and medication management services, individual and/or group therapy and psychological services if necessary. Dates and times of first appointments are routinely set before the patient leaves Cottonwood.


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