In the landscape of depression treatments, both psychotherapy and medication offer distinct advantages and drawbacks. This prompts a crucial question: Could a combined approach possibly enhance the efficacy of treatment?
How Therapy and Meds Work for Depression
Picture cognitive therapy as a kind of power-up therapy, but it's not a forever thing. It's a quick-ish, straight-to-the-point kind of therapy that can handle a whole slew of psychological issues. So, how does it work for depression? Well, it aims to give patients the know-how to:
Spot those troubling thoughts and mental pictures that crop up just before or during distressing emotions.
Create some mental distance from beliefs that are tucked away in these thoughts and pictures.
Challenge their beliefs. They do this by questioning and experimenting. (Like, what's the proof for this belief? Could there be other ways to understand what sparked this belief?)
Pinpoint the themes in their thoughts and pictures that keep showing up in different situations.
How Does Therapy Stack up Against Meds?
Now, when we pit ADM against cognitive therapy, the former seems to focus on managing symptoms rather than finding a cure. Sure, ADM is good at tackling acute depressive episodes and can even prevent relapses if you keep taking it. But here's the kicker: if patients quit their meds, the risk of future depressive episodes doesn't decrease.
What this tells us is that ADM isn't changing the root cause of depression, which leaves patients more susceptible to future bouts if they stop their meds.
On the flip side, cognitive therapy operates on the idea that wonky beliefs and unhelpful ways of processing information (which feed into negative thinking patterns) are key players in causing depression. The theory is that if you fix these dodgy thought patterns, you'll reduce not just immediate distress but also the risk of symptoms cropping up again.
Do We Have Proof That Therapy Works?
You bet! Plenty of studies back up the long-term benefits of psychotherapy for depression. For example, in one study, 267 women with major depression were split into three groups: those getting antidepressants, those getting cognitive behavioral therapy (or CBT, another name for cognitive therapy), and those referred to community mental health services.
The surprising result? For those with severe depression, CBT seemed to have more staying power. While those on meds started to slide after six months, the CBT group just kept getting better. Why? Researchers think it's because CBT equipped patients with some killer coping skills that helped them keep up their progress.
What About Mixing Therapy and Meds?
Great question! To see if the combo of psychotherapy and medication is the ultimate depression-fighting duo, researchers took a good hard look at 17 studies involving major depression. These studies all put combined treatment up against a single treatment option.
What they found was that combined treatment offered a slight edge in effectiveness—a finding that held steady across all the studies. From what we see in the literature, adding therapy to medication seems especially potent for patients dealing with chronic or severe depression. And combining cognitive-behavioral therapy with meds might be just the ticket for preventing relapses, especially among folks stopping their meds.
A deep dive into 52 studies with 4,734 depressed patients concluded that meds might be the best go-to for dysthymia (a type of chronic depression), and that mixed treatments worked better for depressed outpatients and older adults.
For patients with dysthymia, meds did better than therapy, but mixed treatment didn't do significantly better than either meds or therapy on their own. So, for these folks, meds might be the best starting point, at least in the short run.
In older adults, meds and therapy were on par, but mixed treatment did significantly better than meds alone. So, for this group, it seems like a mix-and-match approach might be best.
For outpatients, mixed treatment beat out either therapy alone or meds alone. So, it seems like this combined approach might be the top choice for this group.
References:
Cuijpers, Pim, et al. “Personalized Treatment of Adult Depression: Medication, Psychotherapy, or Both? A Systematic Review.” Depression and Anxiety, vol. 29 2012, pp. 855–864.
DeRubeis, Robert J., et al. “Cognitive therapy versus medication for depression: treatment outcomes and neural mechanisms.” Nature Reviews | Neuroscience, vol. 9, 2008, pp. 788-796.
Friedman, Michael A., et al. “Combined Psychotherapy and Pharmacotherapy for the Treatment of Major Depressive Disorder.” Clinical Psychology: Science and Practice, vol. 11, no. 1, 2004, pp. 47-68.
Siddique, Juned, et al. “Comparative Effectiveness of Medication Versus Cognitive-Behavioral Therapy in a Randomized Controlled Trial of Low-Income Young Minority Women with Depression.” Journal of Consulting and Clinical Psychology, vol. 80, no. 6, 2012, pp. 995–1006.