Best Depression Treatment: The One You Want
Antidepressants or Therapy? Patient's Preference Most Effective
How Patients See Their Depression continued...
Treatment is more than just antidepressant medications or psychotherapy, Elmore says; it's really about people making an effort to combat their depression by controlling it and making themselves feel better.
"What this study is about is something profound: The phenomenology of the patient has an impact on the way treatment works," Elmore says. "There are issues with any treatment for depression. With behavior therapy, there is homework. With drugs you have to take them. If you don't like homework, or if you do not like taking pills, you will not do it and you will not benefit."
Chaney says that patients who choose a particular treatment have expectations it will work. Those expectations may boost the treatment's effect.
"If, because of their own experience or that of family members or significant others, a patient has the expectation that medication is going to help, then they may well prefer that and get a benefit. On the other hand, if they think psychotherapy may help, that has a big impact on whether that is successful for them or not."
A Wake-Up Call to Doctors
There's a lesson here for primary-care doctors -- usually the first health-care professional a person with depression sees.
If their doctor merely refers them to a mental health specialist, Chaney says, many patients will simply fail to seek further help. But when doctors ask about patients' treatment preferences, they are more likely to end up with a helpful prescription or referral. That's especially true if a trained nurse practitioner or physician assistant follows up the visit with a call.
"Medical education is moving in the direction of helping primary-care doctors deal with the mental-care issues that come to them," Chaney says. "One part of this skill set is listening to the patient's preference and taking this into account."