Psychotherapy may be as useful as drugs in treating depression, study suggests

Cognitive behavioral therapy is as effective as antidepressant medication in treating severely depressed patients, according to a study in the July issue of the American Journal of Psychiatry (Vol. 156, No. 7, p. 1007-1013).

The study takes a second look at data from four previous randomized clinical trials that compared cognitive behavioral treatment with drug therapy in 169 severely depressed patients. The analysis includes data from the National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program, a 1989 study that set the standard for treating acute depression. That study concluded that antidepressant medication is more effective than cognitive behavioral therapy in treating severely depressed patients. Since then, treatment guidelines for severe depression have indicated that antidepressant medication is superior to cognitive behavioral therapy.

However, a closer look at the data shows that of the 250 patients in the NIMH study, only 53 severely depressed patients received medication or cognitive behavioral therapy, says Robert DeRubeis, PhD, author of the current study and associate professor and director of clinical training in the department of psychology at University of Pennsylvania. People believed the superiority of medication to cognitive behavioral therapy was supported by a large study, says DeRubeis. In actuality, he says, it only had the illusion of being a large study.

The combined results of these four randomized clinical trials don't support the inference that antidepressants are superior to cognitive behavioral therapy, he says.

DeRubeis recommends that, until more data become available, the field should recognize and treatment guidelines should reflect that neither antidepressant medication nor cognitive behavioral therapy has proven superior in the treatment of severely depressed patients.

--L. Rabasca



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