Depression is common, is the leading cause of disability and suffering, and costs society more than 1 trillion dollars worldwide. Cognitive and behavioral therapies (CBT) are effective for treating depression. However, even if everyone who is depressed is able to obtain evidence-based treatments, existing treatments succeed in reducing the burden of depression disorders by only 35%, suggesting that more needs to be done to alleviate the burden of illness. Targeting depression before it begins is another way to minimize its impact given that effects of depression accumulate with each episode. leading to greater disability and costs to the individual, family, and society. Many studies have demonstrated CBT is effective in preventing depression. However, research has yet to target or demonstrate that a psychosocial intervention is effective in preventing symptoms of depression induced by pharmacological substances.
In this randomized, controlled, pilot study, Dr. McGinn and her colleagues sought to demonstrate that a psychological intervention would be feasible and show preliminary effectiveness for the prevention of pharmacologically induced depression, specifically in those receiving treatment for Hepatitis C. HCV patients commonly receive Interferon (IFN) delivered intravenously over the course of multiple weeks. Unfortunately, up to 40% of patients who receive this treatment develop depression symptoms among their side effects, a phenomenon that in many cases directly affects their ability to complete potentially life saving treatment for their Hepatitis C. Without a resolution to this side effect, a considerable fraction of patients who receive IFN are stuck facing depressive and potentially suicidal symptoms or the medical ramifications of discontinuing the treatment altogether.
Despite the prevalence of this side effect, very little research has been done to minimize the impact of depression using psychological therapies, leaving a large gap in academic literature that our team hoped to at least begin to fill with this study. Because CBT is effective in treating and preventing primary depression, Dr. McGinn and colleagues hypothesized that it would also be effective in preventing medication-induced depression.
The study used a novel cognitive and behavioral depression prevention program developed by Dr. McGinn, which uses a guided symptom exposure (GSE-CBT) to artificially trigger symptoms of depression using a range of stimuli such as music and sad memories and then teaches patients CBT skills so they are prepared to understand, tolerate, and manage symptoms of depression if and when they arise in the future.
Patients were randomly assigned to one of two groups: the experimental group received the GSE-CBT prevention protocol and the control group attended group sessions where they received psychoeducation and support. Participants received three sessions (CBT or psychoeducation and support) before the first infusion of IFN and four sessions afterwards. Researchers measured self-reported depression symptoms at multiple time points to gauge the progress of both groups. In the experimental group, Dr. McGinn and colleagues also measured how well the therapists adhered to CBT principles to ensure that CBT was being delivered as intended and at a high skill level. Patient’s attendance, interaction, and satisfaction with the training was measured to see if the intervention was feasible and acceptable in this population.
The main takeaways from this study were that GSE-CBT training is a feasible prevention intervention for patients receiving IFN. Patients were highly engaged in the study, complied with therapy assignments, and reported a high degree of satisfaction with the CBT sessions. Throughout the study, patients in the GSE-CBT group also had lower depression levels than those in the control group. However, the latter results were not statistically significant, likely due to the fact that the sample was small and because patients in the control group received more psychological education and support than those who normally receive IFN.
This pilot study demonstrates that a psychosocial prevention intervention is feasible for use in patients at risk for developing pharmacologically induced depression and that a guided symptom exposure augmented CBT protocol has the potential to prevent symptoms of depression that develop as a side effect to taking these medications. Results are preliminary and future studies should use larger samples to test the intervention in populations at risk for developing medication-induced depression. These findings also open the door for larger and more in depth studies using the GSE-CBT prevention program in other populations at risk for developing anxiety and depressive disorders.