Changing the path of treatment for depression

Dr. Joel Town, Clinical Psychologist at the QEII Health Sciences Centre
Dr. Joel Town, Clinical Psychologist at the QEII Health Sciences Centre

Depression is among the most serious health problems facing our society, yet the current treatments available remain fairly limited.  Antidepressants are a good first line treatment for some but are not effective for up to 50% of those taking them. There are many reasons for this – including the fact that we all have different bodies, brains, and experiences.

Dr. Joel Town is a Clinical Psychologist at the QEII Health Sciences Centre's Abbie JLane (AJL) Memorial Building with the Mental Health and Addictions Services Centre for Emotions and Health. Town has been examining the effectiveness of psychotherapy in treatment resistant depression (TRD), with a specific focus on intensive short-term dynamic psychotherapy (ISTDP). This form of treatment helps the patient identify and address the emotional factors that result in and exacerbate depression, with the goal of building the patient’s awareness and capacity to experience emotions that adversely affect their mood.

“The guidelines, in terms of guiding what clinicians and health authorities should do is very limited for those with treatment resistant depression,” said Town. “We felt it was important to conduct a study, which was embedded in our clinical services and with the clinicians who actually provide patient care to Nova Scotians who have treatment resistant depression.”

Dr. Town’s findings in his initial study indicated that ISTDP treatment results in a greater improvement in patients’ well-being, compared to routine treatments with a mental health team.

Long term benefits

Because treatment resistant depression is often a chronic and enduring condition, patients can often relapse. So, the next step for Town’s research team was to study whether improvement was sustained and maintained 12 -18 months after treatment, compared with patients receiving ongoing treatment from mental health teams.

The results supported the team’s prediction that patients who received ISTDP held their gains and these improvements in depressive symptoms were larger than those seen in patients receiving treatment as usual at the 18-month study period.

The team also found that although 20 sessions of ISTDP is an enhanced treatment, over the course of 18 months costs are comparable, or slightly less, than providing ongoing routine treatment. These findings demonstrated that this treatment option may in fact be a more cost-effective alternative to routine visits with community mental health teams for secondary care treatment of reoccurring depression.

“This is important, because the need for mental health care services is very high, so stakeholders are conscious around what treatments we provide and who we provide it to,” said Town. “We’ve learned that early access to weekly talk therapy treatments, like ISTDP, is more effective because proportionately, people feel better faster, their energy improves quicker, and therefore it’s cost effective.”

Learning to recognize and experience emotions

In his third study focused on this topic, Dr. Town’s team examined “how” ISTDP works and the importance of addressing avoided feelings of anger when treating depression. Studies have shown that depressed patients report that suppressing anger results in higher levels of depressive symptoms.

“What’s really interesting is that with depression we often think about expressions of anger and sadness as a symptom – it’s something that we should avoid,” said Town. “This can give the message that emotions are bad. So, what we wanted to look at is whether ISTDP is working the way we think it works. Does providing a safe space for people to make sense of feeling such as sadness or anger contribute to change? We found that the treatment does seem to work as we thought it would, and that a focus on just being able to talk about these anxiety provoking emotions is actually part of the ingredients that helps people get better.”

Town noted that the study findings are important because they will help provide training opportunities for therapists.

“We are now able to sit with therapists and look at the recordings they have of their actual treatment to help show the markers of which patients are going to benefit from looking at these emotions and how to facilitate that process,” said Town.

According to Dr. Town, as recently as five to six years ago treatment guidelines said very little about people with treatment resistant depression. But now, for example, the new upcoming UK National Institute for Health and Care Excellence (NICE) guidelines for depression (which are probably the most prominent mental health guidelines in the world) are likely to recommend psychotherapy if a patient has patient hasn’t had satisfactory outcomes following a couple of rounds of antidepressants.

“That’s a direct result of studies like ours showing that actually we need to change paths, not just keep going with what we’re doing,” said Town.

Supporting new research opportunities

Town’s research was made possible through the support he received from the Nova Scotia Health Research Fund, as well as matched funding from the Department of Psychiatry and a charitable donation. This internal funding program aims to build the capacity of Nova Scotia Health researchers and helps to catalyze new research opportunities.

“As a clinician researcher, finding the time, resources and support to be able to conduct research can be very difficult,” said Town. “This funding has actually allowed me to be able to do research, which is clinically based, that will directly impact the services which we work in, and allow the actual people who are providing services to contribute to how we think they can be improved over time. And so, it simply would not have been possible without this grant.”

More information on the award program can be found here.

The Nova Scotia Health Research Fund is an initiative of the Innovation Hub. Nova Scotia Health’s Innovation Hub leads research, innovation and discovery within Nova Scotia’s healthcare system to deliver high-impact solutions for patients and providers. Through strategic partnerships, Nova Scotia Health’s Innovation Hub is transforming health care through leading-edge research, the best available evidence, and innovative solutions.

There are thousands of mental health and addictions professionals who provide support, programs and services to Nova Scotians across the province. To learn more, visit the website for Mental Health and Addiction Services at Nova Scotia Health.