Oct. 9, 2015 -- It's often recommended as the first type of treatment for people with depression.
But a recent study found that the benefits of talk therapy, also known as psychotherapy or counseling, are exaggerated in medical publications. Some studies over the years have hinted the same thing about antidepressant medications.
If you have depression, where does that leave you? Is talk therapy worth a try? We asked several mental health experts to weigh in on the topic and clear up the confusion.
What Did the Most Recent Study Find?
Some media headlines suggest that the new study found talk therapy isn't helpful, and that's simply not true, experts say.
"The finding of the study has been sensationalized in the wrong direction," says Rajnish Mago, MD. He's the director of the Mood Disorders Program at Thomas Jefferson University in Philadelphia. "It is very important to realize that this study has not at all -- NOT at all --shown that psychotherapy doesn't work."
Study co-author Steven Hollon, PhD, explains: "Talk therapy actually works quite well -- just not as well as the published literature would suggest." Hollon is a professor of psychiatry, psychology, and human development at Vanderbilt University.
What the research does address is the long-time concern of "publication bias" -- the idea that studies are more likely to be printed when they report good findings rather than bad (or unpopular) ones. There are two ways this can happen: 1) The study isn't published at all, or 2) The outcome is "cherry picked," meaning the beneficial aspects of research are emphasized, and things that "don't go so well" are left out of the paper, Mago says.
"Our study shows that publication bias inflates the apparent effectiveness of psychotherapy or medications, but even after we adjust for it, these treatments work much better than [if you don't use them at all]," Hollon explains.
To determine that, Hollon and researchers identified NIH-funded grants awarded to researchers in the United States to study psychological treatment for major depression. His team then determined if the findings from each grant had been published. If not, they obtained data from the grant investigators. After taking the data information from the unpublished work into consideration, Hollon's team learned that the true effect of talk therapy dropped slightly [25%].
So, Does Talk Therapy Help People With Depression?
"Absolutely, as do medications," Hollon says. "It is clear that the existing literature makes things look better than they actually are, but there is no question that people do better in treatment than not."
Christiane Manzella, PhD, clinical director of the Seleni Institute, agrees. "Talk therapy remains an appropriate and evidence-based intervention for depression. And while it’s important to continue to refine [the methods used to gather and report evidence], this result does not invalidate talk therapy as a treatment method."
"It's important to keep the context in mind," Mago says. "They aren't saying psychotherapy for major depression doesn't work. They are just saying it works a little bit less than what we thought. How much of a difference are we talking about? It's not a dramatic change. The estimate [25%] doesn't really markedly change opinion about how psychotherapy does or does not work."
What About Antidepressants?
A 2008 study found that the benefits of depression medications have also been exaggerated in published literature. As with talk therapy, researchers concluded these meds still work better than nothing at all.
"Antidepressants actually work quite well,” and the types known as selective serotonin reuptake inhibitors are safe, Hollon says.
The question in studies has been how they really work. "We get a really big placebo effect in the treatment of depression, especially for patients with less severe depression," Hollon says. In other words, people sometimes feel better after being prescribed an antidepressant simply as a result of going into treatment. "The bottom line for patients with less-severe depression is that anything works better than nothing."
Given All The Confusion, What Can I Do to Relieve My Depression?
Always seek help if you're feeling depressed. Treatment depends on the severity of the mood disorder.
"If it's mild or moderate depression, you can use either psychotherapy or medication, but in severe cases, you should use both together," Mago says. "It's like if I have a minor injury to my knee. They'll recommend physical therapy, but if my knee is broken, you're going to first do surgery first and then PT."
Don't give up on getting treated if the first treatment you get doesn't make you feel better. Many different medications are available, as well as several types of talk therapy -- including cognitive behavioral therapy, interpersonal therapy, and supportive or psychodynamic therapy -- all of which are mentioned in the new study.
"Changes in medications or therapeutic interventions may be needed, which is why it’s so valuable to work together with a skilled mental health provider," Manzella says.
Is Exercise a Valuable Alternative to Antidepressants?
Exercises boosts the levels of feel-good hormones, called endorphins, in your body. It doesn't address the underlying chemical changes that lead to depression, but it can still be helpful.
"Physical movement and activity energizes us and helps us feel better physically, which can influence our mood," Manzella says.
Many studies suggest that exercise might work as well as antidepressants in some cases. The literature is nowhere near as plentiful as it is for medications or talk therapy, but experts say it is encouraging.
"We routinely encourage our clients in cognitive or behavioral therapy to increase their level of activity," Hollon says. "We are less certain that exercise helps, but at the least it does not harm and likely does considerable good.”
Can Other Lifestyle Changes Help?
Good habits can make you feel better both physically and emotionally. Here are some tips:
- Get enough sleep.
- Eat nutritious food.
- Limit your screen time, including television.
- Find support and reach out to friends.
What's the Bottom Line?
Treatment for depression works, Hollon says.
The most important step is to reach out for help.
"Treating depression can be hard work, but you don’t have to do it alone. A therapist’s job is to understand and help you. Together you can make decisions about the interventions that will be the most effective to treat your symptoms," Manzella says.