Depression is a painful and debilitating condition that is often difficult to recover from and difficult to treat. Usual treatment is medication plus psychotherapy. But what happens when this does not work?
Treatment Resistant Depression is the term used when adequate medication treatment fails. Up to half of patients prescribed medication do not recover and up to 20% do not benefit from multiple medication trials. When this occurs it is more likely that doctors will change medication rather than choose psychotherapy, despite evidence that psychotherapy can be useful. CBT (Cognitive Behaviour Therapy) has been found superior to GP care as usual and long-term psychoanalytic therapy has also been found efficacious compared to GP treatment as usual.
There is recent evidence now that short-term psychodynamic therapy can be an effective treatment. One form of short-term psychodynamic psychotherapy is Intensive Short-Term Dynamic Psychotherapy (ISTDP) and has been found an effective treatment for people with Treatment Resistant Depression.
The group from Dalhousie University Center for Emotions and Health, Halifax Nova Scotia, used a single blind parallel group design which means it is one of the highest levels of evidence in such a study. They studied 60 people, 30 of whom were given the ISTDP treatment and 30 of whom were allocated to a Community Mental Health Team and given usual support. The ISTDP treatment consisted of 20 sessions provided by four clinicians (1 psychiatrist and 3 clinical psychologists) treating on average 7 people each. Medication was kept stable but if changes were made these were monitored and records maintained in both groups.
Measurement of depression and other functions were conducted at baseline, 3 months and 6 months. They showed that both groups had similar scores before treatment. Then at 3 months the ISTDP group had a depression score of 16.68 and the CMHT group had 20.08. At 6 months the gap was wider with scores at ISTDP – 12.92 and CMHT – 18.74.
This study has shown that ISTDP is an effective from of treatment for a very difficult condition that causes significant distress and disruption to people’s lives and is costly to society in lost time and income and in high health care costs.
Moreover, this study showed that psychotherapy as an alternative to medication can be an effective from of treatment – not only in conjunction with medication but as an effective alternative.
For further information about the Centre for Emotions and Health go to www.istdp.ca.
Locally in Australia ISTDP is practiced at a number of locations including: