woman talking to therapist
LinkedIn

Depression is the second most common mental health disorder in the United States and around the world, which means effective depression treatment is an important component of our healthcare system. It also means that mental health researchers and health scientists engage in a continuous effort to find new and effective depression treatment that can improve the lives of people diagnosed with major depressive disorder (MDD) and other forms of depression.

Worldwide, estimates from the World Health Organization (WHO) indicate the following:

  • Around 280 million people have clinical depression
  • Around 70 million received treatment (25%)

In the U.S., data shows from the 2021 National Survey on Drug Use and Health (2021 NSDUH) shows the following:

  • 21 million adults 18+ had depression
    • 12.6 million received treatment (61%)
  • 5 million adults 18+ had depression with severe impairment
    • 9.1 million received treatment (64.8%)

While rates of depression treatment in the U.S. are higher than those reported worldwide, it’s widely known that some patients never experience symptom relief. In fact, with standard treatment, recent data in studies here and here show the following:

  • 50% of patients report no improvement
  • 50% of patients relapse within two-years
  • That’s a recovery rate of about 25%

Most of us understand the symptoms of depression are extremely uncomfortable and cause serious disruption in daily life. For a person with severe depression, however, the symptoms are more than uncomfortable. In some cases, they can prevent an individual from participating in the essential activities of daily life. These include personal hygiene, eating regularly, and adequate sleep. In addition, the symptoms of depression – mild, moderate, or severe – can disrupt relationships, impair work and academic performance, and degrade self-esteem, wellbeing, and overall life satisfaction.

In this article, we’ll discuss a new study that targets a specific symptom of depression: anhedonia.

Depression Treatment: Traditional Approaches and New Ideas

The study “Preliminary Clinical and Cost Effectiveness Of Augmented Depression Therapy Versus Cognitive Behavioral Therapy For The Treatment Of Anhedonic Depression,” published in July 2023, examines the differences in treatment effect between a traditional approach to depression treatment – cognitive behavioral therapy (CBT) – and a new approach to depression treatment, called augmented depression therapy (ADT).

For decades, CBT has been the first-line treatment for a variety of mental health disorders and issues, including, but not limited to:

The reason it’s well-known and widely used is that it’s effective for a wide range of symptoms. CBT helps millions of people every year manage difficult symptoms and live productive lives. CBT is a solution-focused form of psychotherapy treatment that helps patients explore and understand the relationship between thoughts, feelings, and behaviors.

Here’s an overview of the CBT process:

  1. Therapist and patient define the problem
  2. In a collaborative process, therapist and patient set treatment goals
  3. Therapist introduces core CBT concepts:
    1. Identifying he relationship between thoughts and behavior
    2. Creating the ability to replace automatic negative thoughts with positive, productive thoughts
    3. Enhancing the ability to recognize cognitive distortions, or beliefs based on untrue/inaccurate assumptions
  4. Therapist and patient collaborate on techniques designed to modify thoughts and behavior
  5. Together, therapist and patient work on applying and consolidation new skills, in order to apply them in the real world
  6. Before official CBT treatment ends, therapist and patient create plans and identify tools and skill to prevent relapse
  7. Discharge from therapy.

The National Alliance on Mental Illness (NAMI) summarizes CBT treatment as follows:

“By exploring patterns of thinking that lead to self-destructive actions and the beliefs that direct these thoughts, people with mental illness can modify their patterns of thinking to improve coping.”

CBT is effective – that’s well-established.

But the authors of the study we introduce above observe that one component of depression treatment with CBT may not address adequately is anhedonia, or the inability to feel pleasure.

Addressing Anhedonia in Depression Treatment

While most treatment plans with CBT focus on cognitive restructuring and changing behavior, they don’t specifically address the phenomenon of low mood, feeling numb, and the inability to derive pleasure from formerly loved activities – or anything, for that matter. The idea is that with cognitive restructuring and behavioral change, emotional change will follow. In other words, CBT therapists help patients create conditions wherein they can thrive, manage their emotions, and live a full life.

Yet close to half of patients with depression who engage in CBT only do not experience sufficient relief to meet criteria for remission. In other words, they need something more. Our answer is to offer new, innovative treatments like transcranial magnetic stimulation and psychedelic therapy. To learn about those approaches, please read the following treatment pages:

Transcranial Magnetic Stimulation

Ketamine and Spravato® Treatment

Those approaches offer help to people with treatment-resistant depression (TRD). In order to address the anhedonia that prevents many patients from experiencing success with traditional treatments like CBT, a group of researchers compared the effectiveness of a new depression treatment called Augmented Depression Therapy (ADepT) with the effectiveness of standard treatment with cognitive behavioral therapy (CBT).

Therapists developed Augmented Depression Therapy (ADepT) to enhance wellbeing and reduce depression symptoms for a sustainable period of time. Here’s an overview of the ADepT protocol and process applied in this study.

ADepT for Depression Treatment: How it Works

  • 15 acute and five follow up sessions
  • Solution-focused. ADepT prioritizes addressing depressive symptoms and reducing anhedonia
  • Two primary goals:
    • Functional recovery: the ability to participate in all typical activities of daily life
    • Enhanced wellbeing: the capacity to experience pleasure, derive meaning from life, and establish healthy social connections
  • SMART action steps. Therapist and patient create Specific, Measurable, Achievable, Relevant, Time-Bound daily actions to address symptoms and reduce anhedonia
  • Positive concept of future. Therapist and patient work on visualizing and mapping pathways to constructive coping skills and increased life satisfaction
  • Therapist and patient work on how to enhance wellbeing by practicing mindful engagement in daily activities.
  • Therapist and patient work to improve and consolidate ADepT skills.
  • Wellbeing Plan. Therapist and patient create a plan to build and enhance wellbeing over time, called a wellbeing signature plan.

To test the effectiveness of ADepT vs. CBT, researchers recruited 82 participants with depression and divided them into two groups. One group participated in ADepT depression treatment, while the other participated in standard CBT depression treatment. Researchers measured scores for depression, wellbeing, anhedonia, positive/negative mood, and anxiety at baseline, six months, twelve months, and eighteen months after initiation of treatment.

Let’s take a look at what they found.

CBT or ADepT for Depression Treatment: The Results

The first thing to report is that ADepT is both a feasible and acceptable form of treatment. That means clinicians are comfortable applying ADepT and that patients will engage in and adhere to an ADepT protocol.

Over the course of the study, 85 percent of ADepT patients completed the six-month follow-up, 78 percent completed the twelve-month follow-up, and 70 percent completed the eighteen-month follow up, which is virtually identical to the completion rate for the CBT group. Therefore, researchers concluded that ADepT is both feasible, from a clinician’s perspective, and acceptable, from a patient’s perspective.

That’s step one. Now let’s see if it helped improve symptoms and reduce anhedonia.

ADepT vs. CBT: Effect on Mental Health and Wellbeing

Depression

  • 6 months: ADepT slightly superior to CBT
  • 12 months: ADepT slightly superior to CBT
  • 18 months: ADepT slightly superior to CBT

Wellbeing

  • 6 months: ADepT superior to CBT
  • 12 months: ADepT superior to CBT
  • 18 months: ADepT superior to CBT

Anhedonia

  • 6 months: ADepT superior to CBT
  • 12 months: ADepT equivalent to CBT
  • 18 months: ADepT superior to CBT

Positive Affect

  • 6 months: ADepT superior to CBT
  • 12 months: ADepT equivalent to CBT
  • 18 months: ADepT superior to CBT

Negative Affect

  • 6 months: ADepT superior to CBT
  • 12 months: ADepT slightly superior to CBT
  • 18 months: ADepT superior to CBT

Anxiety

  • 6 months: ADepT superior to CBT
  • 12 months: ADepT equivalent to CBT
  • 18 months: ADepT equivalent to CBT

We’ll clarify here that both approaches to depression treatment worked to relieve symptoms in the study participants. This data does not devalue CBT, but rather indicates that for patients with depression and high rates of negative affect and anhedonia, ADepT is more effective than CBT. That’s logical, because when we review the ADepT protocol, what we see is a CBT-informed approach that focuses specifically on improving general wellbeing and reducing anhedonia, whereas standard CBT focuses on remission of symptoms and managing disruptive thoughts.

The Next Steps for ADepT

This study accomplished at least three goals:

  1. It showed ADepT is acceptable to patients. 94% of the ADepT group said they’d recommend this treatment to others.
  2. It showed ADepT is feasible for providers. Experience CBT clinicians – with the guidance of reference material – were able to learn how to administer ADepT with minimal additional training.
  3. It showed ADepT can improve wellbeing and reduce anhedonia more effectively than standard CBT.

That means the study was successful and made a positive contribution to our collective knowledge about depression treatment. Therefore, the next step is to repeat similar protocols and replicate these results in random-controlled trials (RCTs) with greater sample sizes and a greater diversity of participants. Or, in scientific language, in the words of the study authors, the next step is to conduct:

“…a large trial powered to detect change in depression and wellbeing that builds on the successful procedures in the current study to test definitively if ADepT is clinically and health-economically superior compared to routine CBT in the treatment of anhedonic depression.”

ADepT shows promise: that’s certain. If and when that promise is fulfilled – meaning successful experimental replication of the results above – we’ll share that information here, and consider ADepT as a potential new protocol for treating our patients with depression accompanied by high levels of anhedonia and negative affect.