Brief psychotherapy in general practice leads to speedier recovery for depressed patients

Evidence for the effectiveness of brief, talking therapies in general practice is lacking. Patients are reluctant to take part in randomised trials when they have no choice over what psychological treatment they might receive. Ward et al (p 1383) compared non-directive counselling and cognitive-behaviour therapy with usual general practitioner care for depressed patients. The trial was designed so that patients with strong preferences for a particular therapy were able to receive it, while the remainder were randomised. Patients receiving a talking therapy were less depressed after four months than those who continued only to see their general practitioner, but by 12 months all patients had done equally well. There were no differences in outcome between patients in either therapy arm or between those randomised to therapy or choosing their therapy. In a parallel cost-effective analysis Bower et al (p 1389) found that, despite more rapid improvement in the first four months in patients receiving a psychological therapy, there were no significant differences in direct costs, production losses, or societal costs between the three treatments at either four or 12 months. These findings must be considered preliminary, given the low power of the cost calculations. On this evidence, however, commissioners of services may decide on service configuration based on factors other than outcomes and costs, such as staff and patient preferences or staff availability.

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