Journal of Psychiatric Practice Vol. 21, No. 2 March 2015 107 Cognitive-behavioral therapy (CBT) is an effica- cious first-line therapy for patients with major depressive disorder (MDD). Due to the limited accessibility of CBT, long wait lists result in delayed treatment, which may affect treatment outcomes. The goal of this pilot study was to obtain preliminary data from a randomized con- trolled trial to determine whether delayed CBT reduces the effectiveness of the therapy com- pared to immediate CBT in patients with MDD receiving pharmacotherapy. Patients were ran- domized to receive immediate CBT (n = 18) or to begin CBT after 6 months (n = 20) and received 14 weekly sessions, followed by two additional booster sessions. During the active treatment months, patients in the immediate group demon- strated reductions in scores on the Beck Depression Inventory II (BDI-II) that were simi- lar to those in the delayed CBT group. However, when the analysis was performed using only data from patients in the delayed group who were still in a depressive episode, there was an overall greater decrease in BDI-II scores in the immediate group vs. the delayed group over the active treatment months, but not specifically at the 6-month endpoint. These findings suggest delays in depression treatment, similar to what occurs with real-world wait list times, may not have a significant impact on the effectiveness of CBT in patients who are already receiving treat- ment as usual. However, such delays may affect the effectiveness of CBT in those patients who remain depressed during the time delay. A larger trial is necessary to confirm these findings. (Journal of Psychiatric Practice 2015;21:107–113) KEY WORDS: cognitive-behavioral therapy (CBT), major depression, efficacy, delayed treatment, quality of life Major depressive disorder (MDD) results in signifi- cant functional impairment, which can affect indi- viduals’ ability to work and perform regular activities. 1,2 Although the mainstay of treatment is typically pharmacotherapy, issues such as medica- tion adherence, failure to achieve remission, and tol- erability can limit the use of antidepressants in this population, thereby increasing the risk of relapse. 3–5 Evidence-based adjunctive psychotherapies such as cognitive-behavioral therapy (CBT), a time-limit- ed psychotherapy, improve remission rates in patients with mood disorders as well as those with anxiety and eating disorders. 6–11 CBT can be as effec- tive as antidepressant treatment during the acute phase of MDD for patients with mild to moderate depression, 12,13 while adolescents and patients with chronic/severe MDD demonstrate greater benefit from a combination of pharmacotherapy and CBT. 14–16 In addition, evidence suggests that CBT has a greater protective effect against relapse than pharmacotherapy. 17–19 Lack of timely access to CBT is a global issue. 20–22 In the United States, psychotherapy-based visits by psychiatrists for MDD and anxiety disorders decreased from 44% in 1996–1997 to 29% in 2004–2005, largely due to an overall decrease in psy- SAKINA J. RIZVI, PhD ARI ZARETSKY, MD AYAL SCHAFFER, MD ANTHONY LEVITT, MD RIZVI: Departments of Pharmaceutical Sciences and Neuros- cience, University of Toronto, and University Health Network; ZARETSKY, SCHAFFER, and LEVITT: Department of Psychiatry, University of Toronto, and Sunnybrook Health Sciences Centre, Toronto. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. Please send correspondence to: Ari Zaretsky, MD, FRCPC, Psychiatrist-in-Chief, Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue FG-24, Toronto, Ontario M4N 3M5. ari.zaretsky@sunnybrook.ca The authors would like to thank Dr. Phillip Maerov for assisting with patient management in this study. This study received internal funding from the Department of Psychiatry, Sunnybook Hospital, Toronto, Ontario, Canada. Dr. Schaffer has received grant support from AstraZeneca and Pfizer and has served on the speakers’ bureau or received consulting fees or honoraria from AstraZeneca, Bristol-Myers Squibb, Eli Lilly & Co., Lundbeck, and Pfizer. Dr. Levitt has acted as a con- sultant for Janssen Ortho and Eli Lilly Canada and has received grant support from Eli Lilly Canada. Dr. Zaretsky has served on the speakers’ bureau and has received honoraria from Pfizer and Eli Lilly & Co. Dr. Rizvi declares no conflicts of interest. DOI: 10.1097/01.pra.0000462603.71983.15 Is Immediate Adjunctive CBT More Beneficial than Delayed CBT in Treating Depression?: A Pilot Study Copyright © Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.