Short term psychological therapy more effective than general practitioner care for depression

November 30, 2000

Randomised controlled trial of non-directive counselling, cognitive-behaviour therapy, and usual general practitioner care for patients with depression. I: Clinical effectiveness

Randomised controlled trial of non-directive counselling, cognitive-behaviour therapy, and usual general practitioner care for patients with depression. II: Cost effectiveness

(Editorial) Economic evaluation and clinical trials: size matters

Two studies in this week's BMJ show that psychological therapy is a more clinically and cost effective treatment for patients with depression than usual general practitioner care in the short term, but that these advantages are lost after one year.

King and colleagues identified 464 patients attending general practices in London and Manchester with depression. Patients were randomly divided into three treatment groups - usual general practitioner care, up to 12 sessions of psychological counselling or up to 12 sessions of cognitive-behaviour therapy. Some patients, who expressed a strong preference, were allowed to choose their treatment.

At four months, patients receiving counselling or cognitive-behaviour therapy showed less depressive symptoms than those receiving usual general practitioner care. Psychological therapies may also be more cost effective, as more benefit was gained with no significant difference in cost between the three treatment groups. However, this advantage was lost 12 months into the study, suggesting that psychological therapies were no more clinically or cost effective than usual care in the long term.

Despite some limitations of the studies, the authors conclude that employing practice based counsellors or behaviour therapists may enable patients with moderately severe depression to recover faster. The findings also suggest that factors other than outcomes and costs - such as staff and patient preferences or staff availability - should be considered when deciding on services, they add.

Michael King, Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, Royal Free Campus, London, UK


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