Cognitive-behavioral therapy (CBT) is an efficacious first-line therapy for patients with major depressive disorder (MDD). Due to the limited accessibility of CBT, long wait lists result in delayed treatment, which may affect treatment outcomes. The goal of this pilot study was to obtain preliminary data from a randomized controlled trial to determine whether delayed CBT reduces the effectiveness of the therapy compared to immediate CBT in patients with MDD receiving pharmacotherapy. Patients were randomized to receive immediate CBT (n=18) or to begin CBT after 6 months (n=20) and received 14 weekly sessions, followed by two additional booster sessions. During the active treatment months, patients in the immediate group demonstrated reductions in scores on the Beck Depression Inventory II (BDI-II) that were similar to those in the delayed CBT group. However, when the analysis was performed using only data from patients in the delayed group who were still in a depressive episode, there was an overall greater decrease in BDI-II scores in the immediate group vs. the delayed group over the active treatment months, but not specifically at the 6-month endpoint. These findings suggest delays in depression treatment, similar to what occurs with real-world wait list times, may not have a significant impact on the effectiveness of CBT in patients who are already receiving treatment as usual. However, such delays may affect the effectiveness of CBT in those patients who remain depressed during the time delay. A larger trial is necessary to confirm these findings. (Journal of Psychiatric Practice 2015;21:107–113)
RIZVI: Departments of Pharmaceutical Sciences and Neuroscience, University of Toronto, and University Health Network; ZARETSKY, SCHAFFER, and LEVITT: Department of Psychiatry, University of Toronto, and Sunnybrook Health Sciences Centre, Toronto
The authors would like to thank Dr. Phillip Maerov for assisting with patient management in this study.
This study received internal funding from the Department of Psychiatry, Sunnybook Hospital, Toronto, Ontario, Canada. Dr. Schaffer has received grant support from AstraZeneca and Pfizer and has served on the speakers’ bureau or received consulting fees or honoraria from AstraZeneca, Bristol-Myers Squibb, Eli Lilly & Co., Lundbeck, and Pfizer. Dr. Levitt has acted as a consultant for Janssen Ortho and Eli Lilly Canada and has received grant support from Eli Lilly Canada. Dr. Zaretsky has served on the speakers’ bureau and has received honoraria from Pfizer and Eli Lilly & Co. Dr. Rizvi declares no conflicts of interest.
Please send correspondence to: Ari Zaretsky, MD, FRCPC, Psychiatrist-in-Chief, Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue FG-24, Toronto, Ontario M4N 3M5. firstname.lastname@example.org