Optimization of Pharmacotherapy through Cognitive Behavioural Therapy in Ambulatory Patients Attending Mental Health Clinic in the University of Uyo Teaching Hospital, Uyo, Nigeria
DOI:
https://doi.org/10.51412/psnnjp.2024.35Keywords:
Cognitive Behavioral Therapy, Depression, Drug adherence, Pharmacotherapy, Relapse, Symptom scoresAbstract
Background: Pharmacotherapy is the most frequently prescribed form of treatment for depression, but usually ineffective due to frequent relapses. The study aimed at speeding up recovery time of depression through the combination of Pharmacotherapy and Cognitive Behavioural Therapy (CBT).
Method: This study is a cohort study. Simple sampling was used to assign participants into the experimental and control groups respectively. A 16 sessions of CBT was carried out during the 4- month period of clinical research while Cognitive Structuring and Journaling were used. Beck Depression Inventory (BDI) was used for collating data at baseline, at two and four-month post baseline. The results were analyzed by using SPSS version 26 software while p-value was considered significant at < 0.05.
Results: The results of the experimental group at baseline showed that 34 (54.8%) of the study participants were found in the minimum depression category (0 - 13) symptom scores. At 2 months, 50 (80.6%) participants were found in the minimum depression category (0 - 13) symptom scores and at 4 months, 62 (100%) participants were found in the minimum depression category (0 - 13) symptom scores. Sixteen study participants in the experimental group were recovered from the moderate depression category to the minimum depression category at two months of intervention and additional twelve study participants were recovered at four months of intervention. The BDI mean symptom scores of study participants in the experimental groups showed that study participants at baseline (15.79 ± 8.68) and 2-month follow-up (8.90 ± 6.63) had reduced BDI symptom scores at 4-month follow-up (4.53 ± 3.35) with a significant variation (p < 0.001) from that of the control group (21.00 ± 9.59). This study observed significant improvement in the BDI symptom scores when psychotherapy was combined with pharmacotherapy in the management of depression.
Conclusion: The study indicated that at 4-month follow-up, study participants receiving CBT and pharmacotherapy had BDI symptom scores (4.53 ± 3.35) that varied significantly (p < 0.001) with the study participants on only pharmacotherapy BDI symptom scores (21.00 ± 9.59).
References
Bains N, Abdijadid S. Major Depressive Disorder (2024) In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing Available from: https://www.ncbi.nlm.nih.gov/books/NBK559078/.
National Research Council (US) and Institute of Medicine (US) Committee on Depression, Parenting Practices, and the Healthy
Development of Children; England MJ, Sim LJ, editors (2009). Depression in Parents, Parenting, and Children: Opportunities to Improve
Identification, Treatment, and Prevention. Washington (DC): National Academies Press (US); 3, The Etiology of Depression. Available
from: https://www.ncbi.nlm.nih.gov/books/NBK215119/.
Sermsak L, Pim S, Robert HL (2014). Chapter Five - Epigenetics of Depression, Editor(s): Schahram Akbarian, Farah Lubin, Progress in
Molecular Biology and Translational Science, Academic Press, 128: 103- 137.https://doi.org/10.1016/B978-0-12-800977-2.0005-X.(https://www.sciencedirect.com/science/article/pii/B978012800977200005X).
Yusuf H, Ohieku JD, Haruna WC, Bello FA,Abdu-Aguye SN (2019). Medication Knowledge and Beliefs in Patients with Major Depressive Disorder at a Tertiary Health Facility in North East Nigeria. Nigerian Journal of Pharmaceutical Research 15(2):143-152. https://dx.doi.org/10.4314/njpr.v15i2.2.
Trivedi MH, Fava M, Wisniewski SR, Thase ME, Quitkin F, Warden D, Ritz L, Nierenberg AA, Lebowitz BD, Biggs MM, Luther JF, Shores-
Wilson K, Rush AJ (2006) Medication Augmentation after the Failure of SSRIs for Depression. New England Journal of Medicine 354 (12): 1243-1252.
Wampold BE (2019) The basics of Psychotherapy: An introduction to theory and practices, 2nd edition. American Psychological
Association. Pages:176. Hundt NE, Amspoker AB, Kraus-Schuman C, Cully JA, Rhoades H, Kunik ME, Stanley MA (2014). Predictors of CBT outcome in older adults with GAD. Journal of Anxiety Disorders 28 (8): 8 4 5 - 8 5 0 , https://doi.org/10.1016/j.janxdis.2014.09.012.
Luo C, Sanger N, Singhala N, Pattricka K, Shamsc I, Shahidd H, Hoanga P, Schmidta J, Leea J, Habera S, Puckeringa M, Buchanana N, Leea P, Nga K, Suna S, Kheysona Cho-Yan Chunge D, Sangerf S, Thabaneg L, Samaan Z (2020). A comparison of electronically-delivered and face
to face cognitive behavioural therapies in depressive disorders: A systematic review and meta-analysis. eClinicalMedicine 24: 100442.https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30186-3/fulltext
Charlson F, Ommeren M, Flaxman A, Cornett J, Whiteford H (2019) New WHO prevalence estimate of mental disorders in conflict setting: a systematic review and meta-analysis. Lancet 394(10194):240-248. World Health Organization (2022a) Mental Health and Covid-19: Early Evidence of the Pandemic's Impact. Geneva. World Health Organization (2022b) Mental Health at Work. Geneva.
Iseselo MK, Ambikile JS (2017) Medication challenges for patients with severe mental illness: experience and views of patients, caregivers and mental health care workers in Dar es Salaam, Tanzania. International Journal of Mental Health Systems 11:17. doi: 10.1186/s13033-017-0126-6
Ahsan YK, Rachna K, George D, Ghavami M (2017). Residual symptoms of schizophrenia: what are realistic treatment goals? Current
Psychiatry 16 (3):34-40.
Onyemelukwe C (2016). Stigma and Mental Health in Nigeria; some suggestions for law reform. Journal of Law, Policy and Globalization
: 63–68.
Dauda ES (2016). Mental Health disorders in Nigeria: A highly neglected disease. Annals of Nigerian Medicine 10:47-48.
Uakarn C, Chaokromthong K, Sintao N (2021) Sample Size Estimation using Yamane and Cochran and Krejcie and Morgan and Green
Formulas and Cohen Statistical Power Analysis by G*Power and Comparisions. APHEIT International Journal 10 (2): 76-86. h t t p s : / / s o 0 4 . t c i - thaijo.org/index.php/ATI/issue/view/17281.
Trivedi MH, Fava M, Wisniewski SR, Thase ME, Quitkin F, Warden D, Ritz L, Nierenberg AA, Lebowitz BD, Biggs MM, James F. Luther,
Shores-Wilson K, and Rush AJ for the STAR*D Study Team (2006) Medication Augmentationafter the Failure of SSRIs for Depression. New England Journal of Medicine 354 (12):1243-1252. DOI: 10.1056/NEJMoa052964.
Bosman RC, Waumans RC, Jacobs GE, Voshaar RCO, Muntinghadt, Batelaan NM, Van Balkom Ajlm (2018) Failure to respond after
reinstatement of antidepressant medication: a systematic review. Psychotherapy and Psychosomatics 87(5): 268-275.
Hollon SD, DeRubeis RJ, Fawcett J, et al (2014) Effect of Cognitive Therapy With Antidepressant Medications vs Antidepressants Alone on the
Rate of Recovery in Major Depressive Disorder: A Randomized Clinical Trial. JAMA Psychiatry71 (10): 1157 – 1164 doi:10.1001/jamapsychiatry.2014.1054
Sheila Menon, Vidya Bhagat (2022) Literature study on the Efficacy of antidepressants with CBT in the treatment of depression. Research Journal of Pharmacy and Technology 15(6):2775- 7.doi:10.52711/0974-360X.2022.00465. https://rjptonline.org/AbstractView.aspx?PID=2022-15-6-69
Psychiatry Online (2010). American Psychiatric Association Practice Guidelines. Practice guideline for the treatment of patients with major depressive disorder: 3rd rev. Washington, DC: American Psychiatric Association. www.psychiatryonline.com/pracGuide/pracGui
deTopic_7.aspx. Accessed October 9, 2022.
Dunlop BW, LoParo D, Kinkead B, et al (2019) Benefits of Sequentially Adding Cognitive- Behavioral Therapy or Antidepressant
Medication for Adults With Nonremitting Depression. American Journal of Psychiatry 176 (4): 275 - 286 .
doi:10.1176/appi.ajp.2018.18091075
Cuijpers P, Cristea I, Karyotak E, Reijnders M (2016) How effective are cognitive behaviour therapies for major depression and anxiety
disorders? A meta analytic update of the evidence. World Psychiatry 15(3):245-258.
David D, Cristea L, Hofmann-Frontiers SG (2018) Why Cognitive Behavioural therapy is the current gold standard of psychotherapy. Front Psychiatry. Available at: www.frontiersin.org.
Menzel ER, Hoffman K (2022) Does cognitive behavioural therapy reduce the recurrence of depression? Evidence-Based Practice 25(7):21- 22.
Rice SM, Goodall J, Hetrick SE, Giberson T, Davey CG, Gleeson J, Parker AG, Amminger GP, McGory PD, Jimenez MA (2014) Online and
social networking interventions for the treatment of depression in young people. A systematic review. Journal of Medical Internet Research 16(9):15-23.
McHugh RK, Whitton SW, Peckham AD (2013). Patient preference for psychological vs pharmacologic treatment of psychiatric disorders:
a meta-analytic review. Journal of Clinical Psychiatry 74:595-602.
Moges S, Bewlete T, Menbenu M (2021) Lifetime relapse and its associated factors among people with Schizophrenia Spectrum disorders who are on follow up at comprehensive specialized hospitals in Amhara region, Ethiopia: a cross- sectional study. International Journal of Mental Health Systems 15(42):75-85.
Semahegn A, Torpey K, Manu A, Assefa N, Tesfaye G, Ankomah A (2020) Psychotropic medication, non-adherence and its associated
factors among patients with major psychiatric disorders: a systematic review and meta-analysis. Systematics Review. 9(1):1-18.
Williams JMG, Crane C, Barnhofer T, Brennan K, Duggan DS, Fennell MJV, Russel IT (2014) Mindfulness-based cognitive therapy for
preventing relapse in recurrent depression: a randomized dismantling trial. Journal of Consulting and Clinical Psychology 82 (2):275-286.
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