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Clinical relevance of findings in trials of CBT for depression

Published online by Cambridge University Press:  23 March 2020

P. Lepping ,
R. Whittington ,
R.S. Sambhi ,
S. Lane ,
R. Poole ,
S. Leucht ,
P. Cuijpers ,
R. McCabe  and
W. Waheed
P. Lepping*
Affiliation:
Betsi Cadwaladr University Health Board, Centre for Mental Health and Society, Bangor University, North Wales, UK Mysore Medical College and Research Institute, Mysuru, India Department of Psychiatry, Betsi Cadwaladr University Health Board, North Wales, UK
R. Whittington
Affiliation:
Department of Health Services Research, University of Liverpool, Liverpool, UK
R.S. Sambhi
Affiliation:
Department of Psychiatry, Betsi Cadwaladr University Health Board, North Wales, UK
S. Lane
Affiliation:
Department of Health Services Research, University of Liverpool, Liverpool, UK
R. Poole
Affiliation:
Betsi Cadwaladr University Health Board, Centre for Mental Health and Society, Bangor University, North Wales, UK
S. Leucht
Affiliation:
Department of Psychiatry and Psychotherapy, Technische Universität München, München, Germany
P. Cuijpers
Affiliation:
Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University and VU University Medical Center, Amsterdam, The Netherlands
R. McCabe
Affiliation:
Mersey Care NHS Trust, Liverpool, UK
W. Waheed
Affiliation:
Lancashirecare NHS Trust, Preston and the University of Manchester, Manchester, UK Centre for Primary care, The University of Manchester, Manchester, UK
*
*Corresponding author. Wrexham Academic Unit, Centre for Mental Health and Society, Technology Park, Wrexham, Wales LL13 7TP, United Kingdom. Fax: +44 1978 726 600. E-mail address:peter.lepping@wales.nhs.uk (P. Lepping).
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Abstract

Cognitive behavioural therapy (CBT) is beneficial in depression. Symptom scores can be translated into Clinical Global Impression (CGI) scale scores to indicate clinical relevance. We aimed to assess the clinical relevance of findings of randomised controlled trials (RCTs) of CBT in depression. We identified RCTs of CBT that used the Hamilton Rating Scale for Depression (HAMD). HAMD scores were translated into Clinical Global Impression – Change scale (CGI-I) scores to measure clinical relevance. One hundred and seventy datasets from 82 studies were included. The mean percentage HAMD change for treatment arms was 53.66%, and 29.81% for control arms, a statistically significant difference. Combined active therapies showed the biggest improvement on CGI-I score, followed by CBT alone. All active treatments had better than expected HAMD percentage reduction and CGI-I scores. CBT has a clinically relevant effect in depression, with a notional CGI-I score of 2.2, indicating a significant clinical response. The non-specific or placebo effect of being in a psychotherapy trial was a 29% reduction of HAMD.

Keywords

Cognitive behavioural therapyDepressionClinical Global Impression ScaleHamilton Rating Scale for DepressionClinical relevance
Type
Original article
Information
European Psychiatry , Volume 45 , September 2017 , pp. 207 - 211
Copyright
Copyright © European Psychiatric Association 2017

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References

http://www.who.int/mediacentre/factsheets/fs369/en/.Google Scholar
American Psychiatric Association, Practice guideline for the treatment of patients with major depressive disorder. 2nd ed. Am J Psychiatry 157Apr suppl.2000Google Scholar
National Institute for Clinical Excellence (NICE) Depression: Management of Depression in Primary and Secondary Care (National Clinical Practice Guideline 90) London: NICE; 2009Google Scholar
Ellis, P, Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines Team for Depression Australian and New Zealand clinical practice guidelines for the treatment of depression. Aust NZ J Psychiatry 2004; 38: 389–407.Google ScholarPubMed
Prins, MAVerhaak, PFBensing, JMvan der Meer, KHealth beliefs and perceived need for mental health care of anxiety and depression - the patients’ perspective explored. Clin Psychol Rev 2008; 28(6): 1038–1058.CrossRefGoogle ScholarPubMed
Cuijpers, Pvan Straten, AAndersson, Gvan Oppen, PPsychotherapy for depression in adults: a meta-analysis of comparative outcome studies. J Consult Clin Psychol 2008; 76(6): 909–922.CrossRefGoogle ScholarPubMed
Leucht, SKane, JMKissling, WHamann, JEtschel, EEngel, RRClinical implications of Brief Psychiatric Rating Scale scores. Br J Psychiatry 2005; 187: 366–371.CrossRefGoogle ScholarPubMed
Lepping, PSambhi, RSWhittington, RLane, SPoole, RClinical relevance of findings in trials of antipsychotics: systematic review. Br J Psychiatry 2011; 198(5): 341–345.CrossRefGoogle ScholarPubMed
Leucht, SFennema, HEngel, RKaspers, MLepping, PSzegedi, ATranslating HAMD-17 into nominal CGI scores: clinical implications in patients with major depressive disorder. J Affect Disord 2013. http://dx.doi.org/10.1016/j.jad.2012.12.001 [pii: S0165-0327(12)00834-8].CrossRefGoogle Scholar
Cuijpers, PGeraedts, ASvan Oppen, PAndersson, GMarkowitz, JCvan Straten, AInterpersonal psychotherapy for depression: a meta-analysis. Am J Psychiatry 2011; 168(6): 581–592.CrossRefGoogle ScholarPubMed
Guy, W, editors. ECDEU Assessment Manual for Psychopharmacology. Washington: US: Department of Health, Education, and Welfare; 1976. p. 218–222.Google Scholar
Hamilton, MDevelopment of a rating scale for primary depressive illness. Br J Soc Clin Psychol 1967; 6: 278–296.CrossRefGoogle ScholarPubMed
Van’t Hof, ECuijpers, PWaheed, WStein, DJPsychological treatments for depression and anxiety disorders in low- and middle- income countries: a meta-analysis. Afr J Psychiatry 2011; 14(3): 200–207.CrossRefGoogle ScholarPubMed
Cuijpers, Pvan Straten, AWarmerdam, LAndersson, GPsychological treatment of depression: a meta-analytic database of randomized studies. BMC Psychiatry 2008;8:36.CrossRefGoogle ScholarPubMed
Lepping, PSchönfeldt-Lecuona, CSambhi, RSLanka, SVLane, SWhittington, R, et al.A systematic review of the clinical relevance of repetitive transcranial magnetic stimulation. Acta Psychiatr Scand 2014; 130(5): 326–341.CrossRefGoogle ScholarPubMed
Moncrieff, JKirsch, IEmpirically derived criteria cast doubt on the clinical significance of antidepressant-placebo differences. Contemp Clin Trials 2015; 43: 60–62.CrossRefGoogle ScholarPubMed
Kontis, DTheochari, ETsaltas, ECognitive therapy for patients with schizophrenia. Lancet 2014; 9941(384): 400CrossRefGoogle Scholar
Cuijpers, PSmit, FBohlmeijer, EHollon, SDAndersson, GEfficacy of cognitive–behavioural therapy and other psychological treatments for adult depression: meta-analytic study of publication bias. Br J Psychol 2010; 196: 173–178.CrossRefGoogle ScholarPubMed
Huhn, MTardy, MSpineli, LMKissling, WFörstl, HPitschel-Walz, G, et al.Efficacy of pharmacotherapy and psychotherapy for adult psychiatric disorders: a systematic overview of meta-analyses. JAMA Psychiatry 2014; 71(6): 706–715. http://dx.doi.org/10.1001/jamapsychiatry.2014.112.CrossRefGoogle ScholarPubMed
Ramsberg, JAsseburg, CHenriksson, MEffectiveness and cost-effectiveness of antidepressants in primary care: a multiple treatment comparison meta-analysis and cost-effectiveness model. PLoS One 2012;7(8):e42003.CrossRefGoogle ScholarPubMed
Zimmerman, MMartinez, JAttiullah, NFriedman, MToba, CBoerescu, DASymptom differences between depressed outpatients who are in remission according to the Hamilton Depression Rating Scale who do and do not consider themselves to be in remission. J Affect Disord 2012;142(1–3):77–81http://www.iapt.nhs.uk/silo/files/iapt-3-year-report.pdfhttp://www.iapt.nhs.uk/silo/files/iapt-3-year-report.pdf.CrossRefGoogle Scholar
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