David Gilfillan1, Gordon Parker2, Elizabeth Sheppard1, Vijaya Manicavasagar3, Amelia Paterson3, Bianca Blanch4, Stacey McCraw3. 1. Black Dog Institute, Sydney, NSW, Australia. 2. Black Dog Institute, Sydney, NSW, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW, Australia. Electronic address: g.parker@unsw.edu.au. 3. Black Dog Institute, Sydney, NSW, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW, Australia. 4. Faculty of Pharmacy, University of Sydney, NSW, Australia.
Abstract
OBJECTIVE: This paper seeks to determine the relevance and likely salience of cognitive behaviour therapy (CBT) as a treatment for melancholic depression. METHODS: The findings of a randomised trial comparing 12-week outcome of 18 patients with melancholic depression receiving antidepressant medication and 11 receivingCBT were evaluated, and qualitative explanations for the outcomes were provided principally by the treating CBT practitioners. RESULTS: In the trial, CBT showed no improvement in depression severity in the first four weeks and then some level of improvement over the subsequent eight weeks. Outcome was superior for those receiving antidepressant medication at 12 weeks and was first demonstrated at four weeks. The benefits of CBT appeared to be in settling anxiety, dealing with cognitive processing of having a melancholic depression and addressing any personality vulnerabilities. CONCLUSION: While a pilot study, our qualitative reports indicate that CBT may provide a useful role in managing melancholia as an adjunct to antidepressant medication. Future studies examining such a combination treatment model should seek to determine if indicative data provided here argue for a sequencing model of CBT being introduced after medication has addressed core biological underpinnings.
RCT Entities:
OBJECTIVE: This paper seeks to determine the relevance and likely salience of cognitive behaviour therapy (CBT) as a treatment for melancholic depression. METHODS: The findings of a randomised trial comparing 12-week outcome of 18 patients with melancholic depression receiving antidepressant medication and 11 receiving CBT were evaluated, and qualitative explanations for the outcomes were provided principally by the treating CBT practitioners. RESULTS: In the trial, CBT showed no improvement in depression severity in the first four weeks and then some level of improvement over the subsequent eight weeks. Outcome was superior for those receiving antidepressant medication at 12 weeks and was first demonstrated at four weeks. The benefits of CBT appeared to be in settling anxiety, dealing with cognitive processing of having a melancholic depression and addressing any personality vulnerabilities. CONCLUSION: While a pilot study, our qualitative reports indicate that CBT may provide a useful role in managing melancholia as an adjunct to antidepressant medication. Future studies examining such a combination treatment model should seek to determine if indicative data provided here argue for a sequencing model of CBT being introduced after medication has addressed core biological underpinnings.