A new study has revealed that combining medication with psychological therapies could significantly reduce the chances of depression returning for patients treated in primary care settings, such as GP clinics. Published in The Canadian Journal of Psychiatry, the research offers fresh hope to millions in the UK grappling with major depressive disorder, a condition that remains a leading cause of disability worldwide. With relapse a persistent challenge for those recovering from depression, these findings underscore the potential of a blended approach to keep symptoms at bay.
The study, a systematic review and meta-analysis led by Dr Waseem Abu-Ashour from Memorial University in Canada, examined 35 studies spanning multiple countries, including the UK. Researchers focused on adults receiving care from family doctors, nurse practitioners, and other primary care professionals. They found that while both medication and non-medication treatments, like cognitive behavioural therapy, individually lowered relapse rates, combining the two proved even more effective. Specifically, the combination approach slashed the risk of depression returning by more than half, compared to a roughly one-quarter reduction with medication alone and a one-fifth drop with psychological therapies alone.
Dr Abu-Ashour explained the motivation behind the study, stating, “Mental health awareness, education, and access to care are issues I am deeply passionate about. In Canada, many face barriers to accessing proper therapies in primary care – particularly psychotherapies – due to a shortage of family physicians and mental health professionals. This study was driven by the need to identify effective strategies for preventing depression relapse in primary care and to inform policies that improve access to both medication and psychotherapy within our communities.”
Major depressive disorder affects people across all walks of life, with lifetime prevalence ranging from 2–21%. For many, the initial relief from symptoms following treatment is overshadowed by the threat of relapse, which can strike 30% to 85% of patients despite ongoing antidepressant use. The study highlights that primary care, where most people first seek help for mental health issues, has been under-researched compared to hospital-based settings. This gap has left GPs and their teams with limited evidence to guide long-term care, making these new insights particularly timely.
Among the psychological interventions, cognitive behavioural therapy and mindfulness-based cognitive therapy stood out. The former reduced relapse risk by 45%, while the latter cut it by 35%. These therapies, which help patients reframe negative thoughts or stay present in the moment, appear to offer lasting benefits when paired with medication. “Our study found that depression relapse remains a major challenge, depending on the type of intervention,” Dr Abu-Ashour noted. “Combination therapy was most effective in preventing relapse, reducing relapse risk by 51%. Psychological interventions like CBT and MBCT were also effective, lowering relapse rates by 34–40%.”
The study also emphasised the importance of long-term treatment. “Long-term treatment duration was critical—relapse prevention was more pronounced in studies with follow-up periods beyond two years,” Dr Abu-Ashour added. This finding highlights the need for sustained treatment strategies to prevent recurrence of depressive episodes.
While the findings are promising, the study also exposed gaps in current knowledge. Many of the reviewed studies lacked detail on patient comorbidities, such as anxiety or past trauma, which could influence relapse risk. Most participants were Caucasian, raising questions about how these treatments might work for more diverse populations. The researchers called for future trials to include longer follow-ups and broader demographics to ensure the results apply widely. “More research is needed in minority and ethnic groups,” Dr Abu-Ashour stressed, underscoring the need for greater inclusivity in mental health research.
Looking ahead, the research team is continuing their work in this area. “We are currently investigating depression relapse in Canada using administrative databases and pharmacy claims. This will help analyse which specific medications and combinations are most effective in preventing relapse and identify risk factors associated with relapse,” Dr Abu-Ashour explained. “We are also planning a cost-effectiveness analysis of different psychotherapies in primary care to guide healthcare providers in making decisions.”
For now, this research offers a beacon of hope for the NHS and patients alike. As primary care teams face growing demand for mental health support, combining treatments could become a cornerstone of relapse prevention. With depression’s toll on work, relationships, and healthcare resources well-documented, these findings may pave the way for more resilient recoveries across the UK. “We hope to drive policy changes that improve access to evidence-based, cost-effective mental health treatments in primary care and help bridge the gap in mental health services across communities,” Dr Abu-Ashour concluded.
