Adult depression study (TADS)

The Tavistock Adult Depression Study (TADS) is the first randomized controlled trial in the NHS to establish if long term psychoanalytic psychotherapy provides relief for patients suffering from chronic depression not helped by the treatments currently provided: antidepressants, short-term courses of counselling or cognitive behavioural therapy.

Clinical experience and existing research suggests that psychoanalytic therapies work, but this study tests the effectiveness of psychoanalytic psychotherapy using this most rigorous of scientific designs. The treatment tested is provided weekly over 18 months, as a treatment for persistent, chronic or treatment resistant depression.

Psychoanalytic psychotherapy sets out to address the personal and psychological issues which are thought to underlie chronic depression.

Methodology

As a pragmatic RCT, this study compared the psychoanalytic psychotherapy with a control group receiving the treatments currently approved by the NICE depression guidance administered by their GP who could refer them on to other specialist provision. Exceptionally, the study included a two-year follow-up after treatment completion.

In order to match the complexity of both the condition and the treatment model under investigation, the main outcome trial is complemented by clinical research and qualitative research methodology.

Impact

The Tavistock Adult Depression Study found that:

The findings of TADS contribute to the development of evidence-based medicine in respect of the most common mental disorder. They will help the National Institute of Health and Clinical Excellence (NICE) as it further develops its recommendations for the treatment of depression.

Status

  • 44% of the patients who were given 18 months of weekly psychoanalytic psychotherapy no longer have major depressive disorder when followed up two years after therapy had ended; for those receiving the NHS treatments currently provided the figure was only 10%.
  • Whilst just 14% of those receiving the psychoanalytic psychotherapy had recovered completely, full recovery occurred in only 4% of those receiving the treatments currently employed
  • In every 6-months period of the trial’s exceptional 3 ½ years of observation of participants, the chances of going into partial remission for those receiving psychoanalytic psychotherapy were 40% higher than for those who were receiving the usual treatments.
  • After two years of follow-up, depressive symptoms had partially remitted in 30% of those receiving the psychoanalytic therapy; in the control condition this figure was again only 4%.
  • Those receiving the psychoanalytic psychotherapy also saw significantly more benefits to their quality of life, general wellbeing and social and personal functioning.
  • Some patients did not benefit. Research is ongoing to identify the reasons underlying the differences in responsiveness.

The TADS started in 2002. Recruitment into the trial ended in March 2010 and the treatment/review period was completed in December 2011. The two-year follow-up period took place in December 2013. The outcome findings have been published in World Psychiatry: The paper was published in the open access journal World Psychiatry http://onlinelibrary.wiley.com/doi/10.1002/wps.20267/pdf

Fonagy, P., Rost, F. Carlyle, J. McPherson, S., Thomas, R., Fearon, P., Goldberg, D, Taylor, D. Pragmatic randomized controlled trial of long-term psychoanalytic psychotherapy for treatment-resistant depression: the Tavistock Adult Depression Study (TADS) World Psychiatry 2015;14:312–321

Research team

Principal investigator: Professor Peter Fonagy

Clinical director: Dr David Taylor

Project co-ordinator: Ms Felicitas Rost

Assistant psychologist: Ms Hannah Ridsdale

Research clinician: Dr Rachel Thomas