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Depression is so common that one in four Canadians will have it in their lifetime, while one in ten experience it now. It is also such a serious problem that experts at Harvard identified it as the fourth-ranked cause of premature death and disability worldwide. One approach to treat it is with antidepressant medication, but many people dislike taking medication because of the side-effects, (sexual dysfunction occurs in 50% of cases), and stop taking the medication. Fortunately, psychologists can provide drug-free, effective treatment for depression. This article will give a brief summary of studies largely published in the psychiatry journals as to the effectiveness of psychological treatment for depression.
One approach that is commonly used by psychologists is cognitive-behavioral treatment (CBT). This approach examines the negative beliefs and thinking that depressed people have, and teaches them to identify and challenge their negative thoughts, and replace them with realistic thoughts. It also helps people engage in behaviors that reduce their depression. Dozens of research studies have evaluated the effectiveness of cognitive-behavioral therapy for depression. One study that summarized these many studies found that depressed patients who had cognitive behavioral therapy (CBT) had better outcomes than 98% of the patients with no treatment. When the criteria is more strict, that a person is cured, rather than just improved, therapy shows a success rate of 62% in treating depression. Cognitive-behavior therapy is also effective across the different degrees of depression. A summary of four major studies that compared CBT to medications found that the "overall (results) comparing antidepressant medication to CBT favored CBT" in severely depressed people. Although CBT is quite effective in treating depression of all levels of intensity, it is important to look at how willing a person is to stay in treatment, versus dropping out before the 12-16 sessions are completed. Though there still is some stigma about being in therapy, dropout rates range from 5% to 13%.3 This compares very favorably to medication, where 36% to 50% of the people drop out of treatment before it is completed (often because of concerns about medication side-effects). When dropout rates are included, out of a hypothetical group of 100 depressed patients who start treatment, 47 will be cured by psychotherapy. Only 29 would be cured by medication alone. Once the treatment is over, the concern about depression is not gone. Relapse prevention is very important, as depression is recurrent, with 80% of the people who experience one major depressive episode going on to experience at least one more, and usually three more episodes. Five studies show that CBT cut the rate of relapse in half or more, compared to those treated by medications. Three other studies examined patients who had been first treated with medications, and then had their residual symptoms treated with either CBT or clinical management. CBT was two to three times more effective (relapse rates of 25-35%) than clinical management of medications (relapse rates of 70-80%) in preventing relapse. Thus, if one assumes a relapse rate of 30%, then of a hypothetical group of 100 patients who start cognitive behavioral therapy, 33 are symptom free 2 years later. In contrast, if one assumes a relapse rate of 75% for people who receive medication, then of a hypothetical group of 100 patients who start pharmacotherapy, after dropouts and relapse, 7 would be symptom free 2 years later. Since 33 patients treated with CBT would be symptom free in 2 years, whereas only 7 treated with medications would be symptom free, one can conclude that CBT is 470% more effective than medications alone. Given the effectiveness of CBT, it is not surprising to learn that it is a cost-effective treatment for depression. Medications may result in 75% higher expected cost to the patient or health care provider in treating depression than CBT. If costs to the community and society are added, medications may result in 33% higher expected costs in total, compared to CBT. Finally, many clients wonder if psychological treatment is sufficient, or if they should take anti-depressant medications as well. Although any decision about starting or stopping medication should only be made in consultation with your physician, the research studies give helpful information. The majority of randomized clinical trials have not found clear improvements with combined therapy (psychotherapy and medications together) relative to psychotherapy alone.3,7, In summary, psychologists can provide effective treatment for moderate or even severe cases of depression, by doing cognitive-behavioral therapy with clients. The drop-out rates are low, and the risk of relapse is significantly lower than with other forms of treatment. CBT is even a cost-effective form of treatment. The issue of treating depression is more complex than this brief article, there are a couple of detailed articles on this website under the heading of "Physicians" The articles are titled "Raising questions about antidepressants" and "Psychotherapy versus medication for depression." Are you concerned you may have depression? Take a confidential online depression screening test at: http://www.med.nyu.edu/Psych/screens/depres.html |
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