Talk Therapy Can Ease Depression, But...
Experts say choice depends on individual patient, treatment availability
"Most insurers do not dictate the type of psychotherapy they'll pay for," Bruno said. "But they may dictate the number of sessions."
The nature of depression varies widely from person to person, so ideally psychotherapy would be individualized. Bruno said that a person who has suffered a trauma, for example, might benefit from short-term "psychodynamic therapy" -- where the therapist tries to help you figure out how past experiences, from childhood onward, may be affecting your mental health now.
"Or sometimes a therapist will use a combination of therapies, depending on what seems best for the patient," Bruno said.
The various forms of talk therapy do have "overlapping features," said James Maddux, university professor emeritus of psychology at George Mason University in Fairfax, Va.
So it's not surprising that the review found no clear differences in effectiveness, on average, according to Maddux, who did not work on the study.
Whatever the name, all psychotherapies offer certain basic things -- like support, empathy and a sense of hope, Maddux noted. And the nuts and bolts have similarities, too -- cognitive behavioral therapy, for instance, puts some focus on a patient's relationships, as interpersonal therapy does.
"I think the take-home message is that, if you're depressed, it's better to get into one of these well-established types of therapies than no therapy at all," Maddux said.
The review excluded trials that compared talk therapy with antidepressant medication. But there has been a good amount of research comparing cognitive behavioral therapy with drugs.
"The results are complex," Maddux said, "but the primary finding is that cognitive therapy works just as well for many people as medication without therapy. For some people, both is probably better than either alone."
For his part, Bruno agreed that a combination of talk therapy and medication may be best for some people. But what the current review emphasizes, he said, is that talk therapy plays a vital role in depression treatment.
"There's often so much emphasis on medication in depression treatment," Bruno said. "This reminds us how important psychotherapy is."
Hollon noted that in the UK, the government is putting 700 million pounds into training providers in research-supported talk therapies. "In the U.S," he said, "we are increasingly relying on primary care physicians to prescribe medications."