Does More Frequent Therapy Lead to Better Long-Term Outcomes for Depression?

What you need to know

• This study compared once weekly versus twice weekly therapy sessions for depression over a 2-year period.
• Twice weekly sessions led to faster improvement initially, but the benefits faded over time.
• By 2 years after treatment, there was no significant difference in depression symptoms between once and twice weekly groups.
• About 40% of patients responded well to treatment, but 20-40% of those later relapsed.
• Cognitive behavioral therapy showed slightly better long-term results than interpersonal therapy, but the difference was small.

Background on depression treatment

Depression is a common mental health condition that can significantly impact a person’s quality of life. While psychotherapy can be an effective treatment, more than half of people with depression do not fully recover with therapy alone. Even among those who do improve, relapse is common - up to 50% of people experience a return of depression symptoms after successful treatment.

Given these challenges, researchers are always looking for ways to improve therapy outcomes for depression. One potential approach is to increase the frequency of therapy sessions. Some previous research has suggested that more frequent sessions may lead to better results. However, it was unclear if having therapy sessions twice a week instead of once a week would lead to better long-term outcomes for depression.

About the study

This study aimed to compare the long-term effects of once weekly versus twice weekly therapy sessions for depression. The researchers also compared two types of therapy: cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT).

The study included 200 adults with major depressive disorder. Participants were randomly assigned to one of four groups:

1. CBT once per week
2. CBT twice per week
3. IPT once per week
4. IPT twice per week

Therapy lasted for 16-24 weeks, with a maximum of 20 sessions. The researchers then followed up with participants for 2 years after treatment ended to assess their depression symptoms over time.

Key findings

Initial benefits of twice weekly sessions faded over time

In the short-term, patients who had twice weekly sessions showed faster improvement in their depression symptoms compared to those who had weekly sessions. However, this advantage decreased over time:

• At 9 months after starting treatment, the twice weekly group still had significantly lower depression scores.
• By 12 months, the difference was much smaller and no longer statistically significant.
• At the 2-year follow-up, there was no significant difference in depression symptoms between the once weekly and twice weekly groups.

No difference in relapse rates

The researchers also looked at how many patients initially improved but then experienced a return of depression symptoms (relapse). There was no significant difference in relapse rates between the once weekly and twice weekly groups.

Modest advantage for cognitive behavioral therapy

When comparing the two types of therapy, CBT showed slightly better long-term results than IPT. Patients who received CBT had a larger decrease in depression symptoms over the 2-year period. However, the difference between CBT and IPT at the 2-year point was small.

Overall response and relapse rates

Across all groups:

• About 40% of patients showed a good response to treatment initially
• Of those who responded well, 20-40% later experienced a relapse of depression symptoms

What this means for depression treatment

This study suggests that while more frequent therapy sessions may lead to faster initial improvement, the long-term benefits are less clear. By 2 years after treatment, patients who had weekly sessions caught up to those who had twice weekly sessions.

For patients and healthcare providers, this means that twice weekly sessions could be helpful for achieving faster relief from depression symptoms. However, weekly sessions may be sufficient for long-term management of depression.

The study also reinforces that relapse is a significant concern in depression treatment. Even among patients who respond well to therapy initially, a substantial portion experience a return of symptoms within 2 years. This highlights the importance of ongoing support and monitoring after the initial course of therapy ends.

Limitations and future research

There are a few important limitations to consider:

• The study had a high rate of missing data, especially for long-term follow-ups. This could potentially affect the reliability of the results.
• The sample consisted mostly of people with severe depression. The findings may not apply equally to those with milder forms of depression.
• The quality of therapy provided varied, which could have impacted the results.

Future research could explore:

• Whether certain types of patients benefit more from twice weekly sessions in the long-term
• If a combination of initial twice weekly sessions followed by less frequent “booster” sessions could provide better long-term outcomes
• Strategies to reduce relapse rates after successful initial treatment

Conclusions

• Twice weekly therapy sessions for depression lead to faster initial improvement but do not necessarily result in better long-term outcomes compared to weekly sessions.
• Both cognitive behavioral therapy and interpersonal therapy can be effective for depression, with CBT showing a slight long-term advantage.
• Relapse remains a significant challenge in depression treatment, highlighting the need for ongoing support after initial therapy.
• The optimal frequency of therapy sessions may vary for different individuals. More research is needed to personalize treatment approaches.