Responses

PDF

Review
Cognitive-behavioural therapy does not meaningfully reduce depression in most people with epilepsy: a systematic review of clinically reliable improvement
Compose Response

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Statement of Competing Interests

PLEASE NOTE:

  • Responses are moderated before posting and publication is at the absolute discretion of BMJ, however they are not peer-reviewed
  • Once published, you will not have the right to remove or edit your response. Removal or editing of responses is at BMJ's absolute discretion
  • If patients could recognise themselves, or anyone else could recognise a patient from your description, please obtain the patient's written consent to publication and send them to the editorial office before submitting your response [Patient consent forms]
  • By submitting this response you are agreeing to our full [Response terms and requirements]

Vertical Tabs

Other responses

Jump to comment:

  • Published on:
    Why it’s still important to consider referring patients with epilepsy (PWE) with depression for psychotherapy – including Cognitive Behaviour Therapy. Response from the Psychology Task Force of the International League Against Epilepsy
    • Milena Gandy, Clinical Psychologist & Macquarie University Research Fellow , The eCentreClinic, Department of Psychology, Macquarie University
    • Other Contributors:
      • Markus Reuber, Neurologist
      • W. Curt LaFrance Jr, Neurologist and Psychiatrist
      • Avani Modi, Pediatric Psychologist
      • Janelle, L. Wagner, Pediatric Psychologist
      • Laura H Goldstein, Professor of Clinical Neuropsychology
      • Venus Tang, Clinical Psychologist
      • Kirsten A Donald, Pediatric Neurologist
      • Kette D Valente, Pediatric Neurologist and Neurophysiologist
      • Rosa Michaelis, Neurologist and Psychotherapist

    Imagine you are an epilepsy health professional seeing a patient with clinical symptoms of depression. What should you do? If you have read Noble et al.’s [1] recent JNNP review, entitled ‘Cognitive-behavioural therapy does not meaningfully reduce depression in most people with epilepsy…’ you may have become sceptical about the potential of CBT, or psychotherapy in general, to alleviate depression in people with epilepsy (PWE). This recent systematic review pooled data from five small randomised controlled trials (RCTs), with some elements of CBT for PWE, and performed an analysis of reliable change. ‘Pooled risk difference indicated likelihood of reliable improvement in depression symptoms was significantly higher for those randomised to CBT’, but the authors focused on the finding that ‘only’ 30% of patients receiving interventions, compared to 10% of controls, could be considered ‘reliably improved’. Emphasising the fact that over 2/3 of patients did not meet this criterion for improvement, the authors suggest CBT is ‘ineffective’, has ‘limited benefit’ and could even lead to lower ‘self–esteem’ and ‘helplessness’. Notably, the latter conclusions were based on hypothetical reactions to treatment, rather than empirically supported outcomes.

    Therefore, the purpose of this letter, written by the Psychology Task Force of the International League Against...

    Show More
    Conflict of Interest:
    None declared.