Behavioural and Cognitive Psychotherapy

Research Article

A Randomized Controlled Trial of Cognitive Behavioural Therapy as an Adjunct to Pharmacotherapy in Primary Care Based Patients with Treatment Resistant Depression: A Pilot Study

Nicola J Wilesa1 c1, Sandra Hollinghursta1, Victoria Masona1, Meyrem Musaa1, Victoria Burta2, Julia Hydea3, Bill Jerroma4, Glyn Lewisa5 and David Kesslera5

a1 University of Bristol, UK

a2 North Somerset Specialist Drug and Alcohol Service, Weston-Super-Mare, UK

a3 University of Bristol, UK

a4 Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, UK

a5 University of Bristol, UK


No randomized controlled trials (RCTs) have been conducted of cognitive behavioural therapy (CBT) for depressed patients who have not responded to antidepressants, yet CBT is often reserved for this group. We conducted a pilot study for a pragmatic RCT of the clinical effectiveness of CBT as an adjunct to pharmacotherapy in primary care based patients with treatment resistant depression (TRD). Patients on antidepressants for at least 6 weeks were mailed a study invitation by their GP. Those who consented to contact were mailed a questionnaire. TRD was defined as compliance with medication (self-report) and Beck Depression Inventory (BDI) ≥ 15. Those who met ICD-10 depression criteria were eligible for randomization and followed after 4 months. Of 440 patients mailed, 65% responded and 72% consented to contact. Ninety-four percent completed the questionnaire and 82 patients (42%) had TRD. Thirty were subsequently identified as ineligible and 10 did not participate further. Twenty-six of the remaining 42 patients met ICD-10 depression criteria and 25 agreed to being randomized. Twenty-three patients completed the 4-month follow-up questionnaire. Recruitment into a RCT to examine the effectiveness of CBT as an adjunct to pharmacotherapy in primary care based patients with TRD appears feasible and should now be conducted.


c1 Reprint requests to Nicola J. Wiles, Academic Unit of Psychiatry, Department of Community Based Medicine, University of Bristol, Cotham House, Cotham Hill, Bristol BS6 6JL, UK. E-mail: