Sheila Menon, Vidya Bhagat
Sheila Menon1, Vidya Bhagat2
1London College of Clinical Hypnosis Asia, LCCH Asia, 807 Block B Phileo Damansara 1, Jalan Damansara, Section 16/11 Petaling Jaya Selangor 46350 Malaysia.
2A.J. Institute of Hospital Management, Mangalore Rajeev Gandhi University, Mangalore.
Volume - 15,
Issue - 6,
Year - 2022
Introduction: Depression is of global concern to clinicians, researchers and governments. This study seeks to review the benefits of including cognitive behavioural therapy (CBT) as an adjunctive treatment with antidepressants and to explore the role that physical exercise can offer as a treatment for depression. There is considerable literature available on the use of antidepressants with and without CBT. Various neurological studies have identified new roles which suggest the effectiveness of physical exercise as a supportive treatment against depressive symptoms. The production of endorphins can lead to the development of new neuronal growth which may be helpful in the restructuring of neurocognition and thereby protecting against depressive symptoms. Purpose: Current review study aims at scoping the efficacy of antidepressants with CBT and insightful neurocognitive views on the way physical exercise can restructure the cognition of depressive patients which would make the treatment more effective. Method: This literature review study engine proceeds by scoping 72 articles from the previous literature studies and medical news using electronic databases such as PubMed, Medical news, both clinical and the theoretical implications of these findings are discussed. The study also referred to other journals including Psych-INFO, NCBI, and CINAH from 2010 to 2022 which are analysed to draw insightful information concerning the use of antidepressants with CBT and physical exercises to increase the effective treatment for major depression. Conclusion: the current literature study evidences the enhanced efficacy of treatment for depression with CBT in the treatment of depression, its role in reducing relapse episodes of depression and residual symptoms and the efficacy of physical exercises in the treatment of depression. The implication of the study to place these findings in the larger context of treatment selection in managing residual symptoms, reducing the risk of relapse and neurocognitive changes through physical exercise in major depressive disorder (MDD).
Cite this article:
Sheila Menon, Vidya Bhagat. Literature study on the Efficacy of antidepressants with CBT in the treatment of depression. Research Journal of Pharmacy and Technology. 2022; 15(6):2775-7. doi: 10.52711/0974-360X.2022.00465
Sheila Menon, Vidya Bhagat. Literature study on the Efficacy of antidepressants with CBT in the treatment of depression. Research Journal of Pharmacy and Technology. 2022; 15(6):2775-7. doi: 10.52711/0974-360X.2022.00465 Available on: https://rjptonline.org/AbstractView.aspx?PID=2022-15-6-69
1. Manigault KR.The bidirectional relationship between depression and diabetes. US Pharm.2016 Nov17;41(11):26-9.
2. Flynn HA, Warren R. Using CBT effectively for treating depression and anxiety. Current Psychiatry. 2014 Jun; 13(6):45-53.
3. Hollon SD, Jarrett RB, Nierenberg AA, et al. Psychotherapy and medication in the treatment of adult and geriatric depression: which immunotherapy or combined treatment? J Clin Psychiatry. 2005; 66(4):455-468.
4. Miller IW, Norman WH, Keitner GI, Bishop SB, Dow MG. Cognitive-behavioral treatment of depressed inpatients. Behavior Therapy. 1989 Dec 1; 20(1):25-47.
5. Chiara M, et al., Cognitive restructuring, behavioral activation and cognitive-behavioral therapy in the treatment of adult depression: A network meta-analysis. Journal of Consulting and Clinical Psychology. 2021 Jun; 89(6):563.
6. Jones BD, et al. Metabolic variables associated with response to cognitive behavioural therapy for depression in females: A Canadian biomarker integration network for depression (CAN-BIND) study. Journal of Psychiatric Research. 2021 Oct 1; 142:321-7.
7. Brent DA, Holder D, et al., A clinical psychotherapy trial for adolescent depression comparing cognitive, family, and supportive therapy. Archives of General Psychiatry. 1997 Sep 1; 54(9):877-85.
8. Compton SN, March JS, Brent D, Albano AM, Weersing VR, Curry J. Cognitive-behavioral psychotherapy for anxiety and depressive disorders in children and adolescents: an evidence-based medicine review. Journal of the American Academy of Child & Adolescent Psychiatry. 2004 Aug 1; 43(8):930-59
9. Klein JB, Jacobs RH, Reinecke MA. Cognitive-behavioral therapy for adolescent depression: a meta-analytic investigation of changes in effect-size estimates. Journal of the American Academy of Child & Adolescent Psychiatry. 2007 Nov 1; 46(11):1403-13.
10. Antonuccio D, Burns D. Adolescents with Depression. JAMA. 2004 Dec 1; 292(21):2577-9.
11. Jokić-Begić N. Cognitive-behavioral therapy and neuroscience: Towards closer integration. Psihologijske Teme. 2010 Dec 31; 19(2):235-54.
12. Depression. NIMH. May 2016.
13. Berto P, D’Ilario D, Ruffo P, Di Virgilio R, Rizzo F. Depression: cost-of-illness studies in international literature, a review. J Ment Health Policy Econ. 2000; 3(1):3–10.
14. Kessler RC, Aguilar-Gaxiola S, Alonso J, Chatterji S, Lee S, Ormel J, et al. The global burden of mental disorders: an update from the WHO world mental health (WMH) surveys. Epidemiol Psichiatr Soc. 2009; 18(1):23–33.
15. World Health Organization. Depression fact sheet. Genewa: WHO; 2014.
16. Gotlib IH, Hammen CL. Psychological aspects of depression: toward a cognitive interpersonal integration. Clinl. Psychol Rev. 1994; 14(1):90.
17. Collins PY, Patel V, Joestl SS, March D, Insel TR, Daar AS, et al. Grand challenges in global mental health. Nature. 2011; 475(475):27–30.
18. Kendler KS, Thornton LM, Gardner CO. Stressful life events and previous episodes in the etiology of major depression in women: an evaluation of the "kindling" hypothesis. Am J Psychiatry. 2000; 157(8):1243–51.
19. Belsher G, Costello CG. Relapse after recovery from unipolar depression: a critical review. Psychol Bull. 1988; 104(1):84–96.
20. Lee AS, Murray RM. The long-term outcome of Maudsley depressives. The British Journal of Psychiatry. 1988 Dec; 153(6):741-51
21. Kessing LV, Hansen MG, Andersen PK, Angst J. The predictive effect of episodes on the risk of recurrence in depressive and bipolar disorders – a life-long perspective. Acta Psychiatr Scand. 2004; 109(109):339–44.
22. Katon W, Rutter C, Ludman EJ, Von Korff M, Lin E, Simon G, et al. A randomized trial of relapse prevention of depression in primary care. Arch of Gen Psychiatry. 2001; 58(3):241–7.
23. Judd LL, Akaka HS, Zeller PJ, Paulus M, Leon AC, Maser JD, et al. Psychosocial disability during the long-term course of unipolar major depressive disorder. Arch Gen Psychiatry. 2000; 57(4):375–80.
24. Fava GA, Rafanelli C, Grandi S, Canestrari R, Morphy MA. Six-year outcome for cognitive behavioral treatment of residual symptoms in major depression. American Journal of Psychiatry. 1998 Oct 1; 155(10):1443-5.
25. Fava GA The concept of recovery in affective disorders. Psychother Psychosom. 1996; 652- 13
26. Fava GA, Rafanelli C, Cazzaro M, Conti S, Grandi S. Well-being therapy. A novel psychotherapeutic approach for residual symptoms of affective disorders. Psychological medicine. 1998 Mar; 28(2):475-80.
27. Fava GA, Grandi S, Zielezny M, Canestrari R, Morphy MA. Cognitive behavioral treatment of residual symptoms in Primary major depressive disorder. The American Journal of Psychiatry. 1994 Sep.
28. Rafanelli C, Park SK, Fava GA. New psychotherapeutic approaches to residual symptoms and relapse prevention in unipolar depression. Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice. 1999 Jul;6(3):194-201.
29. Watkins ER, Mullan E, Wingrove J, Rimes K, Steiner H, Bathurst N, Eastman R, Scott J. Rumination-focused cognitive–behavioural therapy for residual depression: Phase II randomised controlled trial. The British Journal of Psychiatry. 2011 Oct; 199(4):317-22.
30. Watkins E, Scott J, Wingrove J, Rimes K, Bathurst N, Steiner H, Kennell–Webb S, Moulds M, Malliaris Y. Rumination-focused cognitive behaviour therapy for residual depression: A case series. Behaviour Research and Therapy. 2007 Sep 1; 45(9):2144-54.
31. Judd LL, Paulus MP, Zeller P. The role of residual sub threshold depressive symptoms in early episode relapse in unipolar major depressive disorder. Archives of General Psychiatry. 1999 Aug 1; 56(8):764-5.
32. Paykel ES, Scott J, Teasdale JD, Johnson AL, Garland A, Moore R, et al. Prevention of relapse in residual depression by cognitive therapy – a-controlled trial. Arch Gen Psychiatry 1999; 56: 829–35
33. Deckersbach T, Nierenberg AA, Kessler R, Lund HG, Ametrano RM, Sachs G, Rauch SL, Dougherty D. Cognitive rehabilitation for bipolar disorder: An open trial for employed patients with residual depressive symptoms. CNS Neuroscience & Therapeutics. 2010 Oct; 16(5):298-307.
34. Kennard BD, Stewart SM, Hughes JL, Jarrett RB, Emslie GJ. Developing cognitive behavioural therapy to prevent depressive relapse in youth. Cognitive and Behavioral Practice. 2008 Nov 1; 15(4):387-99.
35. Kroll LE, Harrington R, Jayson D, Fraser J, Gowers S. Pilot study of continuation cognitive-behavioural therapy for major depression in adolescent psychiatric patients. Journal of the American Academy of Child & Adolescent Psychiatry. 1996 Sep 1; 35(9):1156-61.
36. Zhang Z, Zhang L, Zhang G, Jin J, Zheng Z. The effect of CBT and its modifications for relapse prevention in major depressive disorder: a systematic review and meta-analysis. BMC Psychiatry. 2018 Dec; 18(1):1-4
37. Fava GA, Rafanelli C, Grandi S, Conti S, Belluardo P. Prevention of recurrent depression with cognitive behavioural therapy: preliminary findings. Archives of General Psychiatry. 1998 Sep 1; 55(9):816-20.
38. Kazdin AE, Weisz JR. Identifying and developing empirically supported child and adolescent treatments. Journal of Consulting and Clinical Psychology. 1998 Feb; 66(1):19.
39. Guidi J, Tomba E, Fava GA. The sequential integration of pharmacotherapy and psychotherapy in the treatment of major depressive disorder: a meta-analysis of the sequential model and a critical review of the literature. American Journal of Psychiatry. 2016 Feb 1; 173(2):128-37.
40. Biesheuvel-Leliefeld KE, Kok GD, Bockting CL, Cuijpers P, Hollon SD, Van Marwijk HW, Smit F. Effectiveness of psychological interventions in preventing recurrence of depressive disorder: meta-analysis and meta-regression. Journal of Affective Disorders. 2015 Mar. 15; 174:400-10
41. Kennard BD, Emslie GJ, Mayes TL, Nightingale-Teresi J, Nakonezny PA, Hughes JL, Jones JM, Tao R, Stewart SM, Jarrett RB. Cognitive-behavioral therapy to prevent relapse in pediatric responders to pharmacotherapy for major depressive disorder. Journal of the American Academy of Child & Adolescent Psychiatry. 2008 Dec 1; 47(12):1395-404
42. Gautam M, Tripathi A, Deshmukh D, Gaur M. Cognitive behavioral therapy for depression. Indian Journal of Psychiatry. 2020 Jan; 62(Suppl 2): S223
43. Rohan KJ, Lindsey KT, Roecklein KA, Lacy TJ. Cognitive-behavioral therapy, light therapy, and their combination in treating seasonal affective disorder. Journal of Affective Disorders. 2004 Jun 1; 80(2-3):273-83.
44. Gortner ET, Gollan JK, Dobson KS, Jacobson NS. Cognitive–behavioral treatment for depression: Relapse prevention. Journal of Consulting and Clinical Psychology. 1998 Apr; 66(2):377.
45. Fava GA, Grandi S, Zielezny M, Canestrari R, Morphy MA. Cognitive behavioral treatment of residual symptoms in primary major depressive disorder. The American Journal of Psychiatry. 1994 Sep
46. Paykel, E. S., Scott, J., Cornwall, P. L., Abbott, R., Crane, C., Pope, M., & Johnson, A. L. (2005). Duration of relapse prevention after cognitive therapy in residual depression: follow-up of controlled trial. Psychological Medicine, 35(1), 59–68
47. Kennard BD, Emslie GJ, Mayes TL, Nakonezny PA, Jones JM, Foxwell AA, King J. Sequential treatment with fluoxetine and relapse-prevention CBT to improve outcomes in pediatric depression. American Journal of Psychiatry. 2014 Oct; 171(10):1083-90
48. Berlucchi, G. (2009). “Neuropsychology: theoretical basis,” Encyclopaedia of Neuroscience. Amsterdam: Elsevier Ltd. 1001–1006.
49. Bhui, K., and Fletcher, A. (2000). Common mood and anxiety states: gender differences in the protective effect of physical activity. Soc. Psychiatry Psychiatr. Epidemiol. 35, 28–35.
50. Radak, Z., Kaneko, T., Tahara, S., Nakamoto, H., Pucsok, J., Sasvari, M., et al. (2001). Regular exercise improves cognitive function and decreases oxidative damage in rat brain. Neurochemical. Int. 38, 17–23.
51. Ferris, L. T., Williams, J. S., and Shen, C. L. (2007). The effect of acute exercise on serum brain-derived neurotrophic factor levels and cognitive function. Med. Sci. Sports Exerc. 39, 728–734.
52. Oertel-Knochel, V., Mehler, P., Thiel, C., Steinbrecher, K., Malchow, B., Tesky, V., et al. (2014). Effects of aerobic exercise on cognitive performance and individual psychopathology in depressive and schizophrenia patients. Eur. Arch. Psychiatry Clin. Neurosis. 264, 589–604.
53. Greer, T. L., Grannemann, B. D., Chansard, M., Karim, A. I., and Trivedi, M. H. (2015). Dose-dependent changes in cognitive function with exercise augmentation for major depression: results from the TREAD study. Eur. Neuropsychopharmacol. 25, 248–256.
54. Anderson, E., Hovland, A., Kjellman, B., Taube, J., and Martinsen, E. (2015). [Physical activity is just as good as CBT or drugs for depression]. Lakartidningen 112: DP4E.
55. Schuch, F. B., Vancampfort, D., Richards, J., Rosenbaum, S., Ward, P. B., and Stubbs, B. (2016a). Exercise as a treatment for depression: a meta-analysis adjusting for publication bias. J. Psychiatr. Res. 77, 42–51.
56. Kvam, S., Kleppe, C. L., Nordhus, I. H., and Hovland, A. (2016). Exercise as a treatment for depression: a meta-analysis. J. Affect. Disord. 202, 67–86.
57. Cooney, G. M., Dwal., an, K., Greig, C. A., Lawlor, D. A., Rimer, J., Waugh, F. R., et al. (2013). Exercise for depression. Cochrane Database Syst. Rev. CD004366.
58. Morres, I. D., Hatzigeorgiadis, A., Stathi, A., Comoutos, N., Arpin-Cribbie, C., Krommidas, C., et al. (2019). Aerobic exercise for adult patients with major depressive disorder in mental health services: a systematic review and meta-analysis. Depress. Anxiety 36, 39–53
59. Dopp, R. R., Mooney, A. J., Armitage, R., and King, C. (2012). Exercise for adolescents with depressive disorders: a feasibility study. Depress. Res. Treat. 2012:257472.
60. Bjornebekk, A., Mathe, A. A., and Brene, S. (2005). The antidepressant effect of running is associated with increased hippocampal cell proliferation. Int. J. Neuropsychopharmacol. 8, 357–368.
61. Nguyen, L., Kakeda, S., Katsuki, A., Sugimoto, K., Otsuka, Y., Ueda, I., et al. (2019). Relationship between VEGF-related gene polymorphisms and brain morphology in treatment-naive patients with first-episode major depressive disorder. Eur. Arch. Psychiatry Clin. Neurosci. 269, 785–794.
62. Park, S. C. (2019). Neurogenesis and antidepressant action. Cell Tissue Res. 377, 95–106
63. Ernst, C., Olson, A. K., Pinel, J. P., Lam, R. W., and Christie, B. R. (2006). Antidepressant effects of exercise: evidence for an adult-neurogenesis hypothesis? J. Psychiatry Neurosci. 31, 84–92.
64. De Moor, M. H., Beem, A. L., Stubbe, J. H., Boomsma, D. I., and De Geus, E. J. (2006). Regular exercise, anxiety, depression and personality: a population-based study. Prev. Med. 42, 273–279.
65. Duclos, M., and Tabarin, A. (2016). Exercise and the Hypothalamo-Pituitary-Adrenal Axis. Front. Horm. Res. 47, 12–26.
66. Knapen, J., Vancampfort, D., Morien, Y., and Marchal, Y. (2015). Exercise therapy improves both mental and physical health in patients with major depression. Disabil. Rehabil. 37, 1490–14.