Professor Peter Joyce
However, treatment can be a somewhat hit-and-miss affair as clinicians and psychologists try to find the best medication, or best psychotherapy, or a combination of both. For most people with depression there is only a 50 per cent chance that the first treatment will work, either with antidepressants or psychotherapies.
The Department of Psychological Medicine at the University of Otago, Christchurch, is trying to improve the effectiveness of first-treatment response for depression. It has an international reputation for its research into understanding clinical treatment and determining which approaches work best with which patients.
This year it published two more ground-breaking papers in the British Journal of Psychiatry, comparing responses to two established psychotherapies and providing more detailed information on best practice for treating depression.
This is the largest study ever completed, involving the comparison of responses in 176 depressed people to two treatment methods -
nterpersonal psychotherapy (IPT) and cognitive behavioural psychotherapy (CBT).
The first paper, with Associate Professor Sue Luty as lead author, found that treatment response between the two therapies is comparable overall. The second paper, with Professor Peter Joyce as first author, looked at personality as a predictor of response with patients randomised to the two therapies.
Although there has been some scepticism in the research literature that personality is a significant factor in response to psychotherapy, the Otago researchers found a clear difference between the two psychotherapies with people who could be described as anxious and avoidant personalities.
"The results show that anxious or avoidant personalities do better with cognitive behaviour therapy than interpersonal therapy," reports Joyce.
"This relates to the fact that they are very preoccupied with their own anxiety and thought processes, much more so than people who are less anxious and more gregarious. Interpersonal therapy relies on framing treatment through discussion of interpersonal relationships which just doesn't suit anxious and avoidant types."
Joyce says these two papers further clarify clinical approaches for depression using psychotherapies without antidepressant medication. He says this will be useful for mental-health practitioners where medication is not able to be prescribed, such as with psychologists or counsellors.
The big clinical issue is to try to get the right treatment for depressed people as early as possible, and at present this isn't happening," he says.
Joyce says that IPT and CBT are normally used over a period of three months and, if they are then not working, the therapist should move on to some other form of treatment, or perhaps medication.
Both are well-researched psychotherapies which have a good record of effectiveness, particularly CBT which has been researched and used for at least 40 years for the treatment of less severe forms of depression.
"One of the other important results to come from these comparison studies is that, with more severe depression, we found that cognitive therapy also worked in 50 per cent of cases.
This is very interesting as we predicted that the effectiveness of both psychotherapies would decline with the increasing severity of depression, but this was not the case. It raises a number of important questions about automatically using medication with more severe depression, rather than a talking therapy."
FUNDING
Health Research Council