This is an unusual randomised controlled trial conducted by a research team from Arkin Institute for Mental Health in Amsterdam and funded by Eli Lilly. The study measures social functioning as an outcome, as well as the more commonly measured depression symptoms. It aims to find out how much psychotherapy is optimal for depressed people who are also taking antidepressants.
The trial involved 463 adults living in the community with a DSM-IV diagnosis of depression and a baseline score ≥14 on the Hamilton Depression Rating Scale. The researchers put together a sensible set of exclusion criteria.
Participants were randomly assigned to either:
- 8 (45 min) weekly sessions of short psychodynamic supportive psychotherapy, combined with usual antidepressant treatment (fluoxetine, nortriptyline or mirtazapine)
- 8 (45 min) weekly sessions of short psychodynamic supportive psychotherapy, followed by 8 (45 min) fortnightly sessions of short psychodynamic supportive psychotherapy, combined with usual antidepressant treatment
The authors did not state that allocation of patients to treatment arms was concealed.
The outcomes of interest were:
- Improvement in social functioning score at 20 weeks (Groningen Social Disability Scale, GSDS)
- Change in severity of depression at week 24 (17-item HDRS score, clinical global impression of severity and improvement (CGI-S), the depression subscale of the ninety symptom checklist (SCL-90), and the Quality of Life Depression Scale)
All patients were followed up for 24 weeks and the following results were found:
- Social functioning improved significantly by week 20 on 6 of the 11 GSDS sub scales:
- Self-care (p=0.005)
- Citizen role (p=0.001)
- Home/cohabiting (p=0.003)
- Relationship with parents (p=0.012)
- Housekeeping (p=0.001)
- Leisure time (p=0.000)
- However, there was no significant difference between 8 and 16 psychotherapy sessions in social functioning at week 20 (p≥0.1 for all 11 GSDS subscales)
- There was also no significant difference between 8 and 16 psychotherapy sessions in improvement of depression severity on any scale at week 24 (p≥0.3 for HDRS, SCL-90, GCI-S and QLDS)
- Last observation carried forward analysis showed similar results, with no differences between groups
The authors conclude:
At the end of treatment, no clear differences are found between 8 or 16 sessions of psychotherapy – both combined with pharmacotherapy – with regard to severity of depression and social functioning. It is thus still unknown if patients with major depression show more improvement in social functioning and less symptoms of depression after 16 sessions of combined therapy than after 8 sessions. Currently, it seems that for major depression 8 sessions of combined therapy are equally effective as 16 sessions.
Molenaar PJ, Boom Y, Peen J, Schoevers RA, Van R, Dekker JJ. Is there a dose-effect relationship between the number of psychotherapy sessions and improvement of social functioning? Br J Clin Psychol. 2011 Sep;50(3):268-82. doi: 10.1348/014466510X516975. Epub 2011 Mar 8. [PubMed abstract]
It should be noted that not all psychotherapy is the same and success tends to depend on the juncture of theory-person-therapist so far as I understand the buzz!? I had ‘psychotherapy’ in an out-patients psychotherapy department of the local mental health trust hospital but it was CBT and schema-based therapy. If you want an evidence base rather than cheer-leading for meds or talking therapies or for their combination it is a lot trickier! Sometimes psychotherapy is seen as only referring to non-cognitive and behavioural schools of thought – and in this case it refers to only one particular flavour: psychodynamic supportive psychotherapy. http://www.helptoheal.co.uk/therapy-guide.html – this is a website with good descriptions of different types of therapy. You could find it useful; I did! I wouldn’t want this article to put people off therapy in the right kind of environment and the right school if it will help on the basis of this one study! It would be interesting to see studies on function-focussed therapies: http://www.ukasfp.co.uk/
Apologies though about the cheer-leading sentance: it wasn’t intended as an attack on you Elf; it’s just that good studies and bad in isolation can be taken as such and have been by others. I’ll finish reading this Crazy like Us book properly and normal sweet service will be resumed; possibly!? :)