Clinical efficacy of trauma-focused psychotherapies in treatment-resistant depression (TRD) in-patients: A randomized, controlled pilot-study. (March 2019)

• Record Type: Journal Article
• Authors: Minelli, Alessandra; Zampieri, Elisa; Sacco, Chiara; Bazzanella, Roberta; Mezzetti, Nicoletta; Tessari, Elisabetta; Barlati, Stefano; Bortolomasi, Marco
• Is Part Of: Psychiatry research. Volume 273(2019)
• Page Start: 567
• Page End: 574
• Publication Date: 2019-03
• Subjects: Treatment resistant depression -- Clinical trial -- Childhood trauma -- EMDR -- TF-CBT -- Major depressive disorder; Psychiatry -- Periodicals; Psychiatry -- periodicals; Psychiatrie -- Périodiques; 616.89
• DOI: 10.1016/j.psychres.2019.01.070
• Languages: English
• ISSNs: 0165-1781

Abstract

Highlights: Traumatic experiences are associated with an unfavourable treatment outcome. Identification of novel therapeutic approaches in TRD patients is a great challenge. TRD patients could benefit from evidence-based trauma-focused psychotherapies. We found an amelioration in TRD patients treated with trauma-focused psychotherapy. EMDR showed a greater and more persistent reduction in depressive symptomatology. Abstract: In major depressive disorder (MDD) patients, life stress events represent a risk factor for a severe, early-onset, treatment-resistant and chronic endophenotype. Treatment-resistant depression (TRD) patients who have experienced traumatic events could benefit from evidence-based trauma-focused psychotherapies. Because this topic has never been investigated, the aim of this pilot trial was to evaluate whether trauma-focused cognitive-behavioural therapy (TF-CBT) and/or eye movement desensitization and reprocessing (EMDR) can help achieve depressive symptom remission in TRD patients. We carried out a single-blind randomized controlled trial with TRD patients and we compared EMDR ( N = 12) with TF-CBT ( N = 10). Patients received 3 individual sessions per week over a period of 8 weeks. The symptomatological assessments were performed at 4 timepoints: baseline (T0), 4 (T4), 8 (T8) and 12 (T12) weeks. After 24 weeks, a clinical interview was carried out by phone. All TRD patients showed a significant improvement in depressive symptomatology; however, post hoc comparisons showed a significant difference between the two treatment groups, with lower depressive symptom scores in the EMDR than in the TF-CBT group at the follow-up (T12). This effect was partly maintained at 24 weeks. This pilot study suggests that evidence-based trauma-focused psychotherapies, particularly EMDR, can represent effective interventions to treat TRD patients.