Question: In adults with depression, how effective is cognitive behavioural therapy (CBT) alone or combined with pharmacotherapy, compared with pharmacotherapy alone, in improving patient outcomes?

Answer:

Evidence from one systematic review and two additional randomised controlled trials indicates that cognitive therapies may be similarly effective to pharmacotherapy in reducing depressive symptoms and preventing remission. Evidence from one further randomised controlled trial indicated that the addition of cognitive behavioural therapy to usual care (including pharmacotherapy) may reduce symptoms of depression, panic and anxiety and improve quality of life in people with treatment-resistant depression.

The evidence base was limited and studies included in the systematic review, as well as individual randomised controlled trials, had significant methodological weaknesses. Further, high quality research is needed to confirm the findings of these studies. Given the nature of the intervention, investigators should particularly consider the use of independent, blinded outcome assessment.