Type of Treatment for Depression is Less Important than Engagement


An international team of researchers (including Irving Kirsch) found in a review “of 62 pivotal antidepressant trials consisting of data from 13,802 depressed patients” and “115 published trials evaluating efficacy of psychotherapies and alternative therapies for depression” consisting of data from 10,310 depressed patients that the “type of treatment offered is less important than getting depressed patients involved in an active therapeutic program.” The authors suggest, therefore, that treatment ‘should be based on patient preference.’ Results appear in PLoS Hubs Clinical Trials.

Article → Khan, Arif., Faucett, J., A Systematic Review of Comparative Efficacy of Treatments and Controls for Depression. PLoS Hubs Clinical Trials, online July 30, 2012

Related Item:
Depression treatment ‘should be based on patient preference’



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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected].


  1. The “type of treatment” offered is less important than getting people labeled as depressed patients to believe that their despair, and that of their children, is a bona fide medical disease, and that the professionals who come bearing medicalized solutions to the age-old problem of human despair, are seen by those defined as ‘patients’ as possessing a solution to the problem.

    In other words, in direct relation to the degree of faith the believer has in the religion of therapeutism as it relates to human problems of happiness and unhappiness, so shall the believer find absolution in the anointed caste of mind-priests that the laity believes possess a special ‘service’ or ‘skill’ in solving life’s problems.

    If you’re a member of the therapeutic faithful, you too can offer your life’s problems to the endeavor of the hallowed and prestigious “international team of researchers” in the form of an offering called “data”.

    For one’s life problems, and one’s attempts to outsource the solutions to them to become a cherished and polished brick in the wall of the psychiatric monument is a great honor. For it is only with international teams of researchers parsing data that the age-old problem of human unhappiness will ever be cured and banished from this earth like polio. For it is a disease just like any other, according to the scripture.

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  2. This is a really interesting and important article that reinforces the power of non-treatment-specific factors in short-term response to depression treatments. What the authors unfortunately failed to mention as a limitation to the implications of their findings is that long-term differences between treatments may be quite pronounced despite the appearance of short-term equivalence.

    The finding that psychotherapy and antidepressant medication produce similar short-term benefits is well established. So is the finding that psychotherapy protects against relapse far better than medication. A big reason why the mental health system is such a mess is that findings from 6-week clinical trials have served as the near-sole basis for treatment recommendations and clinical practice guidelines. Antidepressants have become the first-line treatment for depression despite the fact that, compared to psychotherapy, they are more expensive, produce significant adverse effects (including suicide), and lead to poor long-term outcomes including relapse and resistance to subsequent antidepressant treatment.

    I fear that zealous biomedical model proponents will note the findings of this study and conclude that since the psychotherapy-placebo difference is roughly equivalent to the antidepressant-placebo difference, (a) previous claims about small differences between the drug and placebo response are in error, and (b) antidepressants and psychotherapy should be regarded as equivalent in desirability and effectiveness.

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  3. Not to mention that the risks of drugs are far greater than the risks of therapy.

    But the real implication of the study, in my mind, is that people who are depressed need someone to care. It may be a giant placebo effect for any treatment – the thing that makes the difference may well be only that someone recognizes and acknowledges that you are struggling and gives you some hope. And if that’s the case, giving hope without damaging someone’s brain is certainly the preferable option!

    Too bad they don’t include peer support groups in their study – I am sure they’d be at least as effective, probably more so, and are certainly the cheapest and probably the safest option to boot.

    —- Steve

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  4. I agree with Irving Kirsch, the Associate Director of the Program in Placebo Studies and a lecturer in medicine at the Harvard Medical School who is quoted as saying; “Depression is a serious problem, but drugs are not the answer. In the long run, psychotherapy is both cheaper and more effective, even for very serious levels of depression. Physical exercise and self-help books based on CBT can also be useful, either alone or in combination.”
    CBT (Cognitive Behavioural Therapy) has a much higher success rate than medication. Studies have shown it decreases severity of depression in most patients who maintain a CBT course, with many patients reporting they never relapsed into depression. CBT based self-help books sees an even larger percentage of success rates and numbers of people reporting to be cured, with very little cost involved – so why is this form of treatment not more widely used?


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  5. I have been diagnosed as Bipolar I and have had both psychotherapy and medication. Ihave had some superb therapists and most of the I have had: job related, interpersonal, career, etc. have been worked out in therapy and, in general, my life is pretty stable. But when a (bipolar) depression sets in it is like my world has collapsed, I am in a deep hole and only death will relieve the pain. A change in medication, or, on several occasions, ECT is needed to bring me out. Once that has occurred, I can return to life as though nothing ever happened. I am a psychiatric professional and I tell most of my patients that both medication and psychotherapy contribute to finding balance. (There are some people who leave my office without a prescription but with a strong recommendation for therapy and others who will do well on just medication. But I don’t believe either should be discounted as a potential contributor to mental stability.

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