Psychotherapies in Treatment of Depression

Copyright © 2011. World Psychiatric Association

Evidence From Controlled Trials

• CBT in acute depression Strong

• CBT in relapse prevention Strong

• IPT in acute depression Strong

• IPT in relapse prevention Limited

• Marital therapy in marital problems Moderate

• Family therapy Some

• Group therapy Limited

Combination with antidepressants is usually preferable and beneficial, without impairing effects

Copyright © 2011. World Psychiatric Association 2

Indications For CBT

Acute Treatment:

• Where patient prefers.

• In mild depression, may be used alone.

• In moderate depression, combine with antidepressants.

• In severe, not beneficial.

In Relapse Prevention:

• Where vulnerability to relapse or recurrence, e.g. residual symptoms not responding to antidepressant, history of relapses, recurrences, symptom return as drug withdrawn.

• Use as adjunct to continuation /maintenance antidepressant.

• Preferably start while during improvement while still some symptoms, so negative cognitions accessible

Copyright © 2011. World Psychiatric Association 3

Indications for Other Psychotherapies

IPT:

• In acute treatment, similar to indications for CBT

• Also where interpersonal problems prominent, combined with antidepressant.

Marital Therapy, Family Therapy:

• Where marital or family problems, during depression or after improvement.

• Combine with antidepressant

Copyright © 2011. World Psychiatric Association 4