DEPRESSION AND FAMILY RELATIONSHIPS

RELATIVES’ CRITICAL COMMENTS AND RELAPSE OF DEPRESSION CRITICAL % RELAPSE P STUDY COMMENTS VAUGHN & 2+ 67 LEFF (1976) 0-1 22 0.032 HOOLEY (1985) 2+ 59 0-1 0 0.014 OKASHA et al (1994) 3+ 73 0-2 20 0.008

THE LONDON DEPRESSION INTERVENTION TRIAL A RANDOMISED CONTROLLED TRIAL OF ANTIDEPRESSANTS VERSUS COUPLE THERAPY THE MAIN PROBLEM WITH DEPRESSION IS NOT IMPROVING THE SYMPTOMS BUT PREVENTING RELAPSE 1 YEAR OF TREATMENT, THEN A SECOND YEAR WITH NO TREATMENT SUBJECTS: DEPRESSED PERSON LIVING WITH A CRITICAL PARTNER (AVERAGE 8 CRITICAL COMMENTS)

THE LONDON DEPRESSION INTERVENTION TRIAL ANTIDEPRESSANT (DESIPRAMINE OR FLUOXETINE) 37 PATIENTS COUPLE THERAPY 12-20 SESSIONS 40 PATIENTS

THE LONDON DEPRESSION INTERVENTION TRIAL ANTIDEPRESSANT (DESIPRAMINE OR FLUOXETINE) 37 PATIENTS COUPLE THERAPY 12-20 SESSIONS 40 PATIENTS

COUPLE THERAPY 1. DEFINING PROBLEMS AND TRYING NEW SOLUTIONS 2. EXAMINING LONG-TERM RELATIONSHIP PATTERNS 3. PREVENTING RELAPSE BY ANTICIPATING LIKELY CRISIS POINTS

DROP-OUTS FROM TRIAL ANTI-DEPRESSANT COUPLE THERAPY PRE-TREAT. 24% 7.5% <6 SESSIONS 22% 5% 6+ SESSIONS 11% 2.5% TOTAL 57% 15%

CONCLUSIONS FROM TRIAL FOR DEPRESSED PATIENTS LIVING WITH A CRITICAL PARTNER COUPLE THERAPY IS MORE EFFECTIVE THAN ANTIDEPRESSANTS FOR TREATING DEPRESSION AND PREVENTING RELAPSE COUPLE THERAPY IS MORE ACCEPTABLE TO PATIENTS THAN ANTIDEPRESSANTS

CONCLUSIONS FROM TRIAL AN ECONOMIC ANALYSIS SHOWED THAT A COURSE OF COUPLE THERAPY COST NO MORE THAN A COURSE OF ANTIDEPRESSANTS

UK GOVERNMENT ANOUNCES BIGGEST RISE IN ANTIDEPRESSANT PRESCRIPTIONS EVER 2008 35.9 MILLION 2009 39.1 MILLION