For many individuals with depression, a prescription for an antidepressant provides relief. That relief is not immediate however. The patient may wait for several weeks before the effects of the medication begin to improve symptoms. For other individuals with depression, that wait can extend far beyond the expected. The patient may try more than one medication before finding one that is effective for them. In the case of a small proportion of depression patients, the relief sought is not possible with an antidepressant medication. They have a form of depression that is hard to treat and does not respond to antidepressants. For those patients, there may be relief in a different form of treatment. A recent study by researchers at the University of Bristol has found that when a patient does not respond to antidepressants, there may be relief through cognitive-behavior therapy (CBT). CBT is a therapy that combines the techniques of cognitive and behavioral therapies and helps patients change their thought patterns in order to improve depressive symptoms. In turn, the therapy helps the patient positively change how they feel. The study, led by Nicola Wiles, Ph.D., involved 469 participants that did not responded to an antidepressant over a period of six weeks or more. The researchers randomly assigned half of the participants to continue with the same care provided by their clinician, which used an antidepressant as the treatment strategy. The other half of the participants were given CBT in addition to taking an antidepressant. Six months after the study began, 46 percent of the participants who had been enrolled in CBT in addition to the usual care had exhibited an improvement. The patients indicated that they had experienced at least a 50 percent decrease in symptoms. Among those who received treatment as usual without CBT, there was a 22 percent reduction in symptoms. Those in the group receiving CBT were more likely to enter remission from depression and to experience fewer symptoms associated with anxiety. Similar results were found at 12 months after the study began. Wiles explains that previously there was no next step for those patients who did not respond to antidepressants. The findings offer an alternative strategy for those who have difficult-to-treat depression. In the UK, where the study was conducted, approximately three percent of adults meet the criteria for depression. In the United States, that number can be as high as seven percent. The authors note that depression is tracking to become the leading cause of disability by 2030 in high income nations. The authors note that there may be limitations for some patients to obtain CBT due to the cost associated with the treatment. In both countries, there is a disconnect between those with depression that has not responded to antidepressants and getting them access to CBT. The findings of the study are published in a recent issue of the journal Lancet.