Tavistock Adult Depression Study: Comparing the effectiveness of usual GP care with once weekly psychoanalytic psychotherapy for people suffering from chronic, treatment-resistant depression

Plain English summary of protocol

Background and Study Aims
Most depressions get better on their own or with some help from a counselling, a form of talking treatment called cognitive behavioural therapy or anti-depressant tablets. But chronic or so-called treatment-resistant depression (TRD), can be more difficult to help. Many people suffer from it all around the world. Its symptoms include feeling very low or without energy over many years. It is difficult to feel pleasure, enjoyment or satisfaction. Sleep may be poor. There may be chronic feelings of worry and stress. Sometimes there are attacks of panic or of anger that feel out of place. You may also worry about your health and feel aches and pains for which no physical cause can be found. There may be personal difficulties in your close relationships, and unhappiness when you were growing up. Unfortunately, with this kind of depression the treatments we have now often cannot help that much.

We are trying to find out whether a talking treatment called psychoanalytic psychotherapy can help this kind of depression. We also want to find out about the kind of treatments that are being used at the moment, and how much they help. As well, we want to understand more about the illness, about its causes and why it lasts for such a long time.

Who Can Take Part?
Men and women, between 18 and 65 years old, who have been depressed for more than two years. To be eligible it is necessary to have received antidepressant treatment or cognitive therapy at least twice without real improvement.

What Does The Study Involve?
We are comparing sixty sessions of weekly individual psychoanalytic psychotherapy (PP) with treatment as it is normally offered. This is known as treatment as usual (TAU). Half of those in the research are offered the psychoanalytic treatment. It is possible to continue to receive treatment with anti-depressants if you wish. If you are in the ‘treatment as usual’ group you receive any treatment recommended by your GP. We ask consent to review your GP medical records. Any personal information in the trial is confidential.

The trial uses questionnaires and interviews to assess the benefits of the treatment. These cover diagnostic issues, your symptoms, personal functioning and quality of life. At first, there is an initial assessment which involves three interviews. A member of the research team will then meet with you every three months for the year and a half in which you will be attending for psychotherapy sessions or in the treatment as usual group. Over the next two years we ask to see you on three more occasions. The total time in which you will be involved in the trial is three and a half years.

What are the possible benefits and risks of participating?

Psychoanalytic psychotherapy involves speaking about the very personal kind of issues that can underlie depression. This can bring relief from the distressing symptoms of depression. It can help people feel more comfortable with some of the big issues in life. This may reduce the likelihood of becoming depressed again in the future especially when there are difficult or painful experiences such as job loss, relationship break-up, bereavement or physical illness.

The therapy can be emotionally painful. Some people find that the prospect of looking at what they feel inside frightening. Others worry about becoming too attached to the therapist or not feeling understood by them. Being open about these worries can usually help. The end of the weekly therapy sessions can be a difficult time because feelings of loss become more intense. This is an expected part of the treatment. We will always try to find ways of helping you come through these feelings.

This kind therapy may not be advisable for some people. In this case we will tell you about other treatments which are more likely to be of help to you.

There are no physical risks to participants in the study. But people with chronic depression often feel suicidal. Unfortunately some may act upon this. We carefully monitor the safety of everyone taking part in the research. The Senior Research Clinician and the Research’s Clinical Director hold a responsibility for patient safety. Whenever we identify a high risk of suicide we seek to arrange the help needed to reduce this.

If you happen to be allocated to receive treatment as usual, we ask you not to have psychoanalytic treatments while you are in the Study. However, when your period in the research comes to an end if you want the psychoanalytic therapy we will help you get it. While the regular research appointments take time, they also provide valuable support.

Where is the study run from?
All the people taking part in the Study come to the Tavistock Clinic. This is at 120 Belsize Lane, London, NW3 5BA which is near Swiss Cottage in North-West London. Those receiving psychoanalytic psychotherapy come for weekly sessions which are at the same time each week apart from breaks for holidays. Each person’s therapist is the same throughout the sessions. All are qualified and experienced psychoanalytic psychotherapists.

When is the study starting and how long is it expected to run for?
The Study began in 2002 and it will end in 2014. The recruitment of new participants stopped in 2010.

Who is funding the study?
The study is funded by The Tavistock Clinic Charitable Foundation and by the Tavistock & Portman NHS Foundation Mental Health Trust. We have received three small grants from the International Psychoanalytic Association.
Who is the main contact?
Ms Felicitas Rost, TADS Project Coordinator, Psychotherapy Evaluation Research Unit, The Tavistock and Portman NHS Foundation Trust,
The Belsize Centre, 94 Belsize Lane, London NW3 5BE, Tel: +44 (0)20 8938 2038, Fax: +44 (0)20 7435 8018,Email: frost@tavi-port.nhs.uk

Study website

Contact information

Study information

Eligibility

Locations

Countries of recruitment

• England
• United Kingdom

Study participating centre

Sponsor information

Funders

Funder type

Charity

Results and Publications

Study outputs

Editorial Notes

02/10/2017: internal review.