For severe depression, antidepressants are the first line of treatment. Psychotherapy is often used along with antidepressants.

Now, findings from a large ongoing international trial have demonstrated that improving treatment outcomes for severely depressed patients by adding psychotherapy treatment to antidepressant medication does not work.

The study, which was presented at the European Congress of Psychiatry, also discovered that patients with severe depression who received further psychotherapy were younger, more likely to be employed, and had less severe initial depression than those who only received antidepressant medication.

The World Health Organization (WHO) estimates that 322 million people worldwide suffer from clinical depression. This is nearly the population of Germany, France, Spain, Italy, and the United Kingdom combined.

Around a third of people with severe depression do not react well to therapy; they are referred to as “treatment-resistant,” which means that therapists must look for methods to improve current treatments.

According to a new study conducted on European patients with major depression (clinically known as Major Depressive Disorder, MDD) who were treated under real-world conditions, about one-third of those treated with antidepressant medication also received psychotherapy, which is a non-pharmacological treatment in which patients discuss their condition with a qualified doctor or therapist. Around 34% of these individuals who were treated with antidepressants and psychotherapy also received Cognitive Behavior Therapy.

Clinicians from the European Group for the Study of Resistant Depression evaluated the effects of combination treatment in 1279 severely depressed adult patients from Austria, Italy, Belgium, Germany, Greece, France, Israel, and Switzerland. Antidepressant medication had been given to these patients in a timely manner.

31.2 percent of individuals who completed the survey went on to undergo more psychotherapy. Those who received additional psychotherapy were younger, better educated, more likely to be working, and had a reduced risk of suicide than those who only received antidepressant medicines.

They also developed severe depression quicker, had more migraines and asthma, and got lower daily antidepressant doses than individuals who were treated primarily with antidepressants.

The Hamilton Rating Scale for Depression and the Montgomery and Sberg Depression Rating Scale were used to assess the severity of depression in each patient. Additional psychotherapy did not improve treatment outcomes, according to the study.

According to Prof. Siegfried Kasper MD (Medical University of Vienna), the lead researcher, “there are two main points that come out of our work.

“Firstly, if you have been treated with antidepressants, additional psychotherapy does not seem to give you better treatment outcomes, even though it may improve your subjective well-being.

“The second point is that those patients suffering from severe depression and receiving additional psychotherapy had more favourable socio-demographic and clinical characteristics than those who didn’t receive additional psychotherapy.”

The findings of the study show “that additional psychotherapy tends to be given to more highly-educated and healthier patients, which may reflect the greater availability of psychotherapy to more socially and economically advantaged patients.”

“Taking these results, and existing clinical guidelines, into account,” according to Dr. Lucie Bartova (Medical University of Vienna), “we would recommend that clinicians and patients follow the recommended treatment paths to ensure the best care for them. If people have any doubts about treatment they should see their psychiatrist to agree how to move forward.”

In a follow-up study, 292 depressed patients who received Cognitive Behavior Therapy, the recommended psychotherapeutic method for severe depression, were compared to 107 patients who received other psychotherapeutic strategies such psychoanalytic psychotherapy or systemic psychotherapy.

There was no difference in treatment outcomes, according to the researchers.

Dr. Livia De Picker (University of Antwerp), who was not involved in the study, commented:

“Despite clinical guidelines and studies which advocate for psychotherapy and combining psychotherapy with antidepressants,” comments Dr. Livia De Picker (University of Antwerp), who was not involved in the study, “this study shows that in real life no added value can be demonstrated for psychotherapy in those already treated with antidepressants for severe depression.

“This doesn’t necessarily mean that psychotherapy is not useful, but it is a clear sign that the way we are currently managing these depressed patients with psychotherapy is not effective and needs critical evaluation.”

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