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Therapy as Good as Drugs for Depression

Learning How to Cope Has Lasting Effects

WebMD Health News

May 23, 2002 -- When patients with severe depression see their primary care physician, psychiatrist, or other healthcare professional, the advice they get is typically straightforward: Get on and stay on an antidepressant medication, often for an indefinite period.

However, according to experts in Philadelphia at the 155th annual meeting of the American Psychiatric Association, a certain type of psychotherapy known as "cognitive therapy" may be as helpful as antidepressant medications in treating severe depression. Additionally, patients who receive cognitive therapy continue to show lasting benefits after their treatment has ended. On the other hand, most patients who only get medication for severe depression will experience a return of their symptoms within a year after stopping treatment.

Cognitive therapy is a specific type of psychotherapy that focuses on the patient's present situation and options the patient has for coping with the present.

"We now know that we have different choices for patients who have severe depression," Robert DeRubeis, PhD, told WebMD. "Staying on an antidepressant medication has been proven to be effective; we now know that cognitive therapy is just as effective." DeRubeis was one of the investigators who presented his findings. He is a professor and chairman of psychology at the University of Pennsylvania in Philadelphia.

The investigators followed 240 patients for one year who had recently had moderate to severe depression. The patients were selected at random to receive either cognitive therapy or antidepressant medication for four months. In each group, 57% of the patients experienced some benefit and completed their treatment.

For the rest of the year, the patients who had been on medication were then randomized to either continue on medication or to receive a placebo pill, or a tablet containing no medication. Among these patients, neither the investigators nor the patients knew which treatment they were receiving.

At the end of a year, 75% of the cognitive therapy group had remained free of a relapse or return of their depression symptoms. Their regular therapy sessions, once or twice weekly, stopped after the initial four months of the study; they were allowed up to three sessions for the rest of the year.

Among the patients who had been on medication, 60% of those who remained on medication avoided relapse. However, among those who were receiving a placebo, only 19% were relapse-free.

"Because the patients who had been in therapy were required to stop treatment, they were comparable to the subjects receiving medication who were switched to placebo," DeRubeis told WebMD. "The therapy patients learned something that would protect them through the year. One could say that a course of cognitive therapy does to your brain what staying on medication does."

"This study shows that there's more than one way to skin a cat," Carl C. Bell, MD, told WebMD. "If you're depressed, you can take a medication and get better. There's another choice: You can do some inner homework in the form of cognitive therapy and get better. You can also do both. You have a choice to fit your preferences." Bell, professor of psychiatry and public health at the University of Illinois in Chicago, was not involved in the study.

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