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    Talk Therapy Is Sometimes Best for Depression

    Drugs Aren't the Only Effective Treatment, Study Shows
    WebMD Health News

    April 4, 2005 -- New research challenges the widely accepted idea that drugs are the only effective, initial treatment for major depression.

    "The message is that there are clearly at least two options for patients who are suffering from moderate to severe forms of depression," says the University of Pennsylvania's Robert J. DeRubeis, PhD, who led one of the research teams.

    The researchers say that their findings do not support current guidelines from the American Psychiatric Association. The guidelines state that most moderately to severely depressed patients require treatment with antidepressant drugs.

    "It appears that cognitive behavioral therapy can be as effective as medications," they write.

    Cognitive therapy is a type of talk therapy that involves changing a person's negative thought patterns.

    Fewer CT Patients Relapsed

    In the initial study by DeRubeis and colleagues, 240 moderately to severely depressed patients were divided into three treatment groups. A total of 120 were treated with the antidepressant Paxil along with either lithium or the trycyclic antidepressant desipramine, if needed. Sixty patients each were treated with either a placebo pill or cognitive therapy.

    Researchers compared antidepressant medication to cognitive therapy and found that response rates were similar for both treatment groups.response rates were similar for both treatment groups.

    After 16 weeks of treatment, response rates were the same for patients treated with antidepressants and cognitive therapy. A total of 58% of both groups responded to treatment. In the group of drug-treated patients, 46% experienced few if any symptoms of depression, compared with 40% of the cognitive therapy patients.

    A follow-up study showed that relapse after withdrawal from treatment may be a bigger problem for patients treated with drugs than for those who receive cognitive therapy.

    This study included 104 of the patients who responded to treatment.

    Both studies were published in the April Archives of General Psychiatry.

    Patients who responded to cognitive therapy were withdrawn from treatment and compared during the next year with patients who had responded to antidepressants and were either kept on the drugs or were unknowingly switched to a placebo. Relapse was defined as a return, for at least two weeks, of symptoms of major depression.

    Researchers found that patients withdrawn from cognitive therapy were less likely to relapse during the continuation phase than patients withdrawn from medication (31% vs. 76%, respectively).

    Patients who had received cognitive behavioral therapy were also no more likely to relapse than the patients who kept taking antidepressants.

    "The cognitive therapy patients did as least as well as those that stayed on the antidepressants," DeRubeis tells WebMD.

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