Comparison of Antidepressants and Therapy

Does cognitive-behavioral therapy work just as well as antidepressants when treating depression? How we perceive our depression is what helps to determine the type of treatment necessary. Antidepressants treat the common symptoms of depression rather than the condition while therapy helps change the thought process so the disease is cured in the end. Many studies are done to provide necessary information to what the answer to this question should be. The following articles provided studies that explained the effects of treatment with medication, with therapy, or a combination of both.

Reviews of research on psychotherapy versus antidepressants with evidence supported methods were used. WebPages along with the reading of numerous studies were used in order to identify all possible information. The articles were reviewed as well as surveys and meta-analysis. It was shown that each article I critiqued used only adult patients and the results show that evidence was provided from a substantial number of randomized clinical trials that each provided the same result of cognitive therapy being the cure for depression and antidepressants being quick symptom relief.

Antonuccio, Danton, DeNelsky hypothesizes that cognitive behavioral therapy is at least as effective as medication in treatment of depression, even if severe. It reviews a wide range of well-controlled studies comparing psychological and pharmacological treatments for depression. The study split cognitive behavioral therapy into three subtypes and a study was done with each type. The three subtypes of cognitive behavioral therapy were pleasant activity therapy, cognitive therapy, and social skills therapy. Pleasant activity therapy involves helping patients increase their occurrence and quality of pleasant activities. Though there were no studies on this therapy alone. However a study was conducted using 97 patients that were randomly assigned to one of the three psychological therapies combined with amitriptyline (150 mg/day) or a placebo for a 2 month period. A total of 64 patients completed treatment and the results were as follows pleasant activity therapy plus placebo was just as effective as it was with the antidepressant.

For cognitive therapy its focus was to address the thought process depressed patients experienced when trying to tell themselves what happens rather than what actually happens and to mediate the impact of events in patient’s lives. This study consisted of 12 weeks of cognitive therapy plus nortriptyline, or cognitive therapy plus active placebo for 87 randomly assigned moderate to severely depressed psychiatric outpatients. Of these 87 outpatients 70 patients completed the study and the result was that cognitive therapy alone was as effective as notriptyline, and there was no addictive effect of the combined treatments. The study also consisted of drawing blood samples every other week to ensure that plasma nortriptyline levels were in target window of 50-150 ng/ml. Of the 70 patients the 44 recovered patients were followed for a year after treatment termination. The end result was that patients who received cognitive therapy with or without nortriptyline were less likely to relapse. The study also provided that patients were more likely to relapse with medication alone.

The last of the subtypes was social skills therapy which addresses the patient’s problems with social interaction in the community and in the home. This study focused on 178 depressed outpatients each being treated with 10 weeks of insight-oriented dynamic psychotherapy, behavior therapy emphasizing social skills, the antidepressant amitriptyline (150 mg/day), or a relaxation control condition. On two random visits during the treatment period unannounced blood samples were drawn to ensure they were obedient. On 9 out of 10 outcomes at the end of treatment and 7 out of 10 measures on the 3 month follow up it showed behavior therapy to be superior. During a 27 month follow up of the four treatments behavior therapy provided a 6 of 7 outcomes. In conclusion the evidence suggests that cognitive-behavioral therapy as a whole is at least as effective as medication in treating depression. Medications have side effects and are often used in suicide attempts while psychotherapy teaches the patient the essential skills to help avert depression which is less cost-effective and more flourishing in preventing future relapses.

This review was very detailed and informative but following the first study they provided other smaller studies which were helpful in backing up their results but it didn't provide a clear understanding to the reader. It was a cluster of studies with no explanation just information thrown into paragraphs and broken into sections. It seemed to add details to the first study but in all each study provided was essential to support their hypothesis. Overall the article was very helpful in explaining and supporting their hypothesis. It also provided a recommendation section for what future studies should focus on that will help further the knowledge of which treatment is better and why.

When deciding on which studies worked and which did not one can not actually know the truth so in order to get a full understanding of the topic you must find numerous studies that focus on the same subject. Various studies were conducted on this topic but they all seemed to come to the same result. The used various techniques to conclude the end result that combined therapy is best but psychotherapy preferably cognitive-behavioral therapy is just as effective alone. Each study concludes that antidepressants are the first line of treatment for symptoms and that therapy actually is what works to cure the disease. These findings are due to the percent of relapses and the long term effect of therapy versus antidepressants.

Researchers at the University of Pennsylvania and Vanderbilt University hypothesized that cognitive therapy to treat moderate to severe depression works just as well as antidepressants. They believed that cognitive therapy would have more lasting effects because it educates and trains the patients with the tools they need to manage their emotions and problems. Researchers state that though antidepressants are effective they do not provide long term cure for the symptoms. The study randomly placed 240 depressed patients in groups that received cognitive therapy, antidepressant medication, or a placebo. The antidepressant group was set up to be twice as large as the other two and they were treated with paxil, lithium or desipramine. Patients from the medication and the cognitive therapy groups showed improvement after 16 weeks at the same rate. The cognitive therapy patients were less likely to relapse in the two years following the end of treatment. This proved that medication did not affect the underlying process of the disorder and