Psychoanalytic psychotherapy can help depressed patients where other treatments fail

1 October 2015

A ground-breaking research study conducted by the Tavistock and Portman NHS Foundation Trust and published in the October issue of World Psychiatry is providing important evidence of the efficacy of long term psychoanalytic psychotherapy (LTPP) for NHS patients suffering from chronic depression.

The Tavistock Adult Depression Study (TADS) is the first randomized controlled trial in the NHS to establish if this type of psychotherapy can provide relief for those not helped by the treatments currently provided: antidepressants, short-term courses of counselling or cognitive behavioural therapy. Crucially, the study, which started over 10 years ago, followed participants for two-years post-intervention to look at long-term therapeutic effects. It found nearly half of patients still saw major improvements two years after therapy had ended.

This kind of depression is a major mental health problem: as many as one in five people who have an episode of depression will suffer a chronic form; the quality of life associated with some of these conditions is similar to that of people suffering from advanced metastatic cancer; suicide rates are high.

The Tavistock Adult Depression Study found that:

• 44% of the patients who were given 18 months of weekly psychoanalytic psychotherapy no longer have major depressive disorder when followed up two years after therapy had ended; for those receiving the NHS treatments currently provided the figure was only 10%.
• Whilst just 14% of those receiving the psychoanalytic psychotherapy had recovered completely, full recovery occurred in only 4% of those receiving the treatments currently employed.
• In every 6-months period of the trial’s exceptional 3 ½ years of observation of participants, the chances of going into partial remission for those receiving psychoanalytic psychotherapy were 40% higher than for those who were receiving the usual treatments.
• After two years of follow-up, depressive symptoms had partially remitted in 30% of those receiving the psychoanalytic therapy; in the control condition this figure was again only 4%.
• Those receiving the psychoanalytic psychotherapy also saw significantly more benefits to their quality of life, general wellbeing and social and personal functioning.
• Some patients did not benefit. Research is ongoing to identify the reasons underlying the differences in responsiveness.

TADS Clinical Director, Dr David Taylor, from the Tavistock and Portman NHS Foundation Trust said:

“These findings point to the value of a whole person approach in patients who have complex or persistent problems with depression. Longer-term psychoanalytic psychotherapy involves the shared commitment of patient and therapist to understanding emotionally painful parts of a depressed person’s life. This may activate a beneficial process of psychological growth with a lasting gain in resilience. This can occur even in those who have had their disorder for many years, have not responded to other treatments and who previously may not have been thought to benefit from psychoanalytic psychotherapy.”

Paul Jenkins, Chief Executive of the Tavistock and Portman NHS Foundation Trust added:

“For those suffering with these kinds of depression there are few other equally well-evidenced treatments available. The Trust is proud of this well-designed random allocation controlled trial which adds considerably to the field of evidence for longer-term treatments in the field mental health. The follow up periods allowed the investigators to monitor the stability of short-term gains and detect those that while slower to develop may be more lasting. These encouraging findings about the effectiveness of longer term psychoanalytic psychotherapy should be taken into account in the current revision of the NICE Guideline for the treatment of Depression in Adults.”

Finally, the Tavistock and Portman NHS Foundation Mental Health Trust wishes to express its gratitude to the patients who generously agreed to take part in the research and to its research partners at University College London and the Anna Freud Centre.

Notes to Editors:

1. For more information or to arrange an interview, please contact: Matt Cooper, Press and Communications Officer on 0208 938 2571 or mcooper@tavi-port.nhs.uk or Laure Thomas, Director of Communications and Marketing on 07711 805 026 

2. The paper was published in the open access journal World Psychiatry:
http://onlinelibrary.wiley.com/doi/10.1002/wps.20267/pdf

Fonagy, P., Rost, F. Carlyle, J. McPherson, S., Thomas, R., Fearon, P., Goldberg, D, Taylor, D. Pragmatic randomized controlled trial of long-term psychoanalytic psychotherapy for treatment-resistant depression: the Tavistock Adult Depression Study (TADS) World Psychiatry 2015;14:312–321

3. Long term psychoanalytic psychotherapy (LTPP) as used in this study consisted of 60 (50 min) sessions of once-weekly individual sessions over 18 months with experienced, well qualified psychoanalysts. The therapy is based on the view that depression is an outgrowth of current life difficulties arising out of painful and continuing ambivalence first felt in relation to those of the greatest emotional significance to the patient early in the course of his/her development. These feelings give rise to problems with psychosocial functioning affecting close relationships. They may also influence healthcare/service providers and the care they offer. LTPP seeks to help patients to develop a psychological capacity to relate to painful personal experiences, memories, feelings, beliefs and relationships in a reflective, yet also active, manner.

4. Epidemiology: Depressive disorders are a major health problem. This holds for low and middle income countries as well as higher income ones. They are associated with a great deal of suffering and involve the waste of much potential. Chronic, difficult-to-treat forms of depression are responsible for a disproportionate part of the large burden of disease attributable to depression globally.