Antidepressants Not Superior to Psychotherapy for Severe Depression

Justin Karter
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On Wednesday, JAMA Psychiatry released a meta-analysis comparing the results of cognitive-behavioral therapy and antidepressant medication in severely depressed populations.  Currently, many practice guidelines suggest that antidepressants be used over psychotherapy for major depressive disorder. The analysis, however, found that “patients with more severe depression were no more likely to require medications to improve than patients with less severe depression.”

In their guidelines for the treatment of depression, both the American Psychiatric Association (APA) and the British Association for Psychopharmacology suggest that while “psychotherapy is sufficient for treating mild depression, antidepressant medications (ADMs) should be used to treat severe depression in the context of major depressive disorder.”  These guidelines are based largely on the results of a randomized control trial conducted by the NIMH.  However, this latest meta-analysis reveals that the difference in treatment outcomes observed in the NIMH trials “were not observed in several other randomized clinical trials (RCTs) of acute-phase treatment.”

While previous meta-analyses have attempted to compare ADMs and CBT for depression, the latest study is unique in that the researchers were able to obtain patient-level data, giving the study “more power to examine accurately moderators of treatment outcomes.”  The researchers reviewed 16 studies that provided individual patient-level data and eight that did not.  All told, the sample included data on 1,700 participants.

The results of the analysis show no significant differences between antidepressants and CBT in response to treatment or remission in patients with severe depression.  “In total, 63% of patients in the ADM condition and 58% of patients in the CBT condition responded to treatment, and 51% of patients in the ADM condition and 47% of patients in the CBT condition met criteria for remission.”

The researchers conclude that “the data are insufficient to recommend ADM over CBT in outpatients based on baseline severity alone.” They also suggest that CBT may be used an effective first-line treatment for severely depressed patients.

 

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Weitz ES, Hollon SD, Twisk J, et al. Baseline Depression Severity as Moderator of Depression Outcomes Between Cognitive Behavioral Therapy vs. Pharmacotherapy: An Individual Patient Data Meta-analysis. JAMA Psychiatry. Published online September 23, 2015. oi:10.1001/jamapsychiatry.2015.1516 (Full Text)

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Justin Karter
MIA-UMB News Editor: Justin Karter is a writer, researcher and community organizer with graduate degrees in both journalism and community psychology. He is a doctoral candidate in Counseling Psychology at UMass Boston, an active member of the Society for Humanistic Psychology, and is currently working on several scholarly projects at the intersection of psychology, social theory, and political philosophy.

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12 COMMENTS

  1. If they ever find a drug that blocks feelings of depression it would be devastating to humanity.

    Why bother doing anything nothing depresses me ?

    Not having money won’t make me feel bad so why goto work ?

    I can’t do that good a job explaining it but feeling bad and sad is a critical part of what makes us tick and without those feelings things would not work out well.

    And without feeling bad how would I know I feel good when I have nothing to compare it too ?

    The whole idea of a happy pill will never work.

    • Yeah, I think these are good points. Besides all the money the drug companies are making from these poisons, what is also happening is a change in our culture. The idea that it is best to numb oneself, rather than make changes in one’s life in order to feel better, has become almost the norm.

      The United States is on its way to becoming a nation of drugged zombies.

    • Exactly. All emotions serve a survival purpose. It would be like a pill that made us not feel pain. No one WANTS to feel pain, but if we didn’t, we’d never know when to move our hand from a hot stove or when to come in out of the sun or that we had just stepped on a nail. Emotions are just the same – they exist to help us survive. Psychiatry’s biggest crime isn’t pushing damaging drugs – it is convincing people that their emotions don’t have meaning or purpose and that the thing to do is to eliminate them rather than figuring out what they’re trying to tell us.

      —- Steve

      • People who can’t feel physical pain have real problems keeping themselves out of harms way. People who don’t feel emotional pain never learn not to harm others because they have no way to develop empathy.

        Psychiatry wants to turn us into psychopaths. No one who has experienced a full range of human emotions wishes to be reduced to that.

  2. Along the lines of this discussion, I suggest readers check van der Kolk, et. al. (2007) “Randomized Clinical Trial of Eye Movement Desensitization and Reprocessing (EMDR), Fluoxetine, and Pill Placebo in the Treatment of Posttraumatic Stress Disorder: Treatment Effects and Long-Term Maintenance.” The research presents significant results using EMDR therapy in treating co-occurring depression and PTSD when compared with Prozac at six month follow-up.

    At 6-month follow-up, 75.0% of adult-onset versus 33.3% of child-onset trauma subjects receiving EMDR achieved asymptomatic end-state functioning compared with none in the fluoxetine group. Journal of Clinical Psychiatry, 2007.

  3. It seems to me that a pertinent question is whether EITHER antidepressant medication or Cognitive Behavioral Therapy generate persistently better results than placing people on a wait list for treatment. When only half to two-thirds of the client population appears responsive to treatment, we need to ask how many folks report better results in six months without any treatment at all.

    When this experiment was done in the 1950s and 60s with in-patient psychotherapy programs for depression and anxiety, there was no statistically significant difference in outcomes for those placed on a waiting list versus those treated in community facilities as in-patients. About half of both groups reported “improvement” after six months. Granting that the psychotherapy of that day was Freudian or Adlerian in character, I must still doubt that modern therapies based on similar underlying premises do much better.

  4. I wonder if they now compared both to say taking part in therapeutic midnight naked dancing around a bonfire and howling to the moon would they obtain similar results? It all sounds like huge placebo effect to me. Whatever you do to people who are “depressed” (whatever that even means in the real world) a proportion of them are going to get better if they believe it’s meant to help. When you do absolutely nothing a proportion of them will recover as well. Finally there will be people who won’t recover no matter what because they happen to have real, persistent problems which aren’t solved with an attitude change. When do we stop pretending we’re dealing with medicine and diseases here?