Is cognitive behaviour therapy of benefit for melancholic depression?
OBJECTIVE
This paper seeks to determine the relevance and likely salience of cognitive behaviour therapy (CBT) as a treatment for melancholic depression.


METHODS
The findings of a randomised trial comparing 12-week outcome of 18 patients with melancholic depression receiving antidepressant medication and 11 receiving CBT were evaluated, and qualitative explanations for the outcomes were provided principally by the treating CBT practitioners.


RESULTS
In the trial, CBT showed no improvement in depression severity in the first four weeks and then some level of improvement over the subsequent eight weeks. Outcome was superior for those receiving antidepressant medication at 12 weeks and was first demonstrated at four weeks. The benefits of CBT appeared to be in settling anxiety, dealing with cognitive processing of having a melancholic depression and addressing any personality vulnerabilities.


CONCLUSIONS
While a pilot study, our qualitative reports indicate that CBT may provide a useful role in managing melancholia as an adjunct to antidepressant medication. Future studies examining such a combination treatment model should seek to determine if indicative data provided here argue for a sequencing model of CBT being introduced after medication has addressed core biological underpinnings.
Black Dog Institute, Sydney, NSW, Australia.
David
D
Gilfillan
Black Dog Institute, Sydney, NSW, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW, Australia. Electronic address: g.parker@unsw.edu.au.
Gordon
G
Parker
Black Dog Institute, Sydney, NSW, Australia.
Elizabeth
E
Sheppard
Black Dog Institute, Sydney, NSW, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.
Vijaya
V
Manicavasagar
Black Dog Institute, Sydney, NSW, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.
Amelia
A
Paterson
Faculty of Pharmacy, University of Sydney, NSW, Australia.
Bianca
B
Blanch
Black Dog Institute, Sydney, NSW, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.
Stacey
S
McCraw
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D010552:Personality Assessment; D010865:Pilot Projects; D016896:Treatment Outcome
D000928:Antidepressive Agents