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Treating Depression – Psychotherapy or Medication?

     

Evidence–based psychotherapy and antidepressant medication are both recommended treatments for depression under current guidelines. They have roughly the same effectiveness with 30 to 40 percent remission rates when each treatment is used alone. Some people respond better to one or the other and often people do not respond to a first treatment for depression. A combination of both treatments is on average more effective, but may not be possible or practical because of time, cost or other barriers.

Predicting effectiveness of medication or psychotherapy

New research looks at a possible means of predicting whether psychotherapy or medication would work better for a specific person.

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Researchers led by Boadie W. Dunlop, M.D., M.S., with Emory University, used MRI brain imaging before and after treatment to determine if they could predict positive response. Study participants were randomly assigned to 12 weeks of either antidepressant medication or cognitive behavior therapy (CBT). Based on measurements of functional connectivity within specific brain regions, they found that those with positive combined scores were much more likely to benefit from treatment with CBT and not benefit from medication. People with negative combined functional connectivity scores were much more likely to benefit from medication treatment, not CBT.

Medication and therapy work in different ways to treat the symptoms of depression. The patients’ differing brain states may reflect their ability to benefit from the different treatment mechanisms, according to the researchers. They conclude that “brain–based measures of major depression are proving superior to clinical measures and patient preferences” in outcomes of depression treatment. This could potentially help people avoid much suffering and lost time to treatments that are ineffective for them.

Does preference for psychotherapy or medication make a difference in the outcome?

Another group of researchers, also lead by Dunlop, looked at whether a person’s preference for psychotherapy or medication for depression affected the outcome of the treatment. Study participants were people being treated for depression for the first time. They were asked their preference for treatment and then were randomly assigned to 12 weeks of treatment with antidepressant medication or CBT. Patients treated with their non–preferred approach fared equally as well as those treated with their preferred approach. People treated with their preferred approach, however, were more likely to complete treatment.

Is sticking with treatment more likely with medication or psychotherapy?

A third study looked at another aspect of the depression treatment process — when people refuse to undertake treatment or drop out of treatment early. Researchers undertook a meta–analysis to look at rates of treatment refusal and drop out for psychotherapy and medication, for depression and other mental health conditions. They found that overall, about eight percent of people refused treatment and about 22 percent dropped out of treatment early. People with depression were much more likely to refuse medication treatment than to refuse psychotherapy. Those treated with medication for depression were more likely to drop out of treatment early than those treated with psychotherapy.

Together, this research can contribute to more efficient and effective treatment for the many people struggling with depression.

     

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Comments (2) Add a Comment

  • Michael Rizzi

    This is very valuable information, but I am curious, and believe it is important to know, about how the different treatments affect the brain regions being studied. Is it known exactly why patients with positive combined functional connectivity scores benefit from CBT more than medication, and why patients with negative scores benefit more from medication? What specific impacts do CBT and medication have on these brain regions, and how do these impacts differ? Also, what antidepressants were used in this study. Lastly, what brain regions were studied? Thank you very much for your time, Michael Rizzi

  • Michael

    This is extremely interesting and useful information! I do have a couple of questions though. Is it known why, exactly, patients with positive combined functional connectivity scores respond better to CBT, and those with negative scores to medication? What are the different effects that each type of treatment has on these regions of a patient's brain? Lastly, why are patients more likely to start and continue psychotherapy than medication? Is it partly due to fear of social embarrassment of being on medication? Thank you, Michael

 

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