Restructuring fragility results of a randomised controlled trial of intensive short-term dynamic psychotherapy (ISTDP) for treatment-resistant depression
Dr Joel Town Plymouth University Peninsula Schools of Medicine & Dentistry
DISCUSSANT: Dr Susan McPherson University of Essex
A decade ago Lord Layard drew attention to the scandal of unmet need for treatment for depression: IAPT was born. A decade on the scandal is that over 1M patients each year are leaving IAPT without having recovered. The NHS ‘set menu’ today – a choice between anti-depressants or (anti-depressants +) CBT / counselling – leaves far too many wanting more. Sadly, the prognosis for those who ‘fail’ these treatments has got bleaker. Less than 1% of IAPT patients in 2016 were offered a choice of psychodynamic treatment. This is despite the fact there have been two randomized controlled trials of psychoanalytic therapies, specifically for treatment resistant depression, since the 2009 NICE guideline. What do we need to do to ensure the NHS offers effective treatments for this group of patients, whom services may see as ‘too risky’ or ‘fragile’?
Dr. Joel Town will present results of a trial of time limited psychoanalytic therapy (20 sessions, ISTDP) versus treatment as usual in a community mental health team (CMHT) for treatment resistant depression. He will discuss the phenomenology of “treatment resistant” depression and will describe the trial design and show how ISTDP treatment works, using video clips from sessions. Finally, he will say whether the trial showed ISTDP was an effective treatment.
Dr. Town is a Senior Research Fellow and Clinical Psychologist who has worked closely with Dr. Allan Abbass, Professor of Psychiatry at Dalhousie University. Together they have been testing the model of psychoanalytic therapy that originated with David Malan’s research work at the Tavistock.
Dr. Susan McPherson is a Senior Lecturer at the University of Essex and worked closely with Professor Phil Richardson setting up and conducting the Tavistock Adult Depression Study (TADS). She is now helping disseminate its findings. In discussing Joel Town’s presentation, she will reflect on what we can now say we know from the two trials in relation to other candidate approaches for treatment resistant depression that NICE are currently reviewing.
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