Cognitive Therapy versus Medications for Depression

BenzodiazepineThere is often a debate about the effectiveness of cognitive therapy versus medication for depression. Below are the findings from some studies that help us the role of cognitive therapy and medications in the treatment of depression.

1. Robert J. Derubeis in the Archives of General Psychiatry did a study with random assignment of 240 patients to 16 weeks of medications, 16 weeks of cognitive therapy, or 8 weeks of pill placebo. Response rates in medications (50%) and cognitive therapy (43%) groups were both superior to placebo.

2. In the same issue of the Archives, Steven D. Hollon, PhD et al, reports on the results of a 12 month study looking at a total of 104 outpatients. Patients who had gotten better with cognitive therapy were withdrawn from treatment (the therapy was stopped) and then compared during a 12 month period with patients who had responded to medications and who either continued on the effective medication or were switched to placebo. Patients withdrawn from cognitive therapy were significantly less likely to relapse during continuation than patients withdrawn from medications (31% versus 76%) and no more likely to relapse than patients who kept taking continuation medication (31% versus 47%).

Conclusion: Cognitive therapy has an enduring effect that extends beyond the end of treatment. It seems to be as effective as keeping patients on medication.

This is a controversial conclusion and a consensus of the literature in general is that medications are more effective than therapy for more severe types of depression. More recently, in an editorial in the renamed Archives (now called JAMA Psychiatry) one author suggested that perhaps now is time to stop focusing on either / or and to recognize that all of the studies find the combination more effective.


Cognitive Therapy vs Medications in the Treatment of Moderate to Severe Depression.
Robert J. DeRubeis, PhD; Steven D. Hollon, PhD; Jay D. Amsterdam, MD; Richard C. Shelton, MD; Paula R. Young, PhD; Ronald M. Salomon, MD; John P. O’Reardon, MD; Margaret L. Lovett, MEd; Madeline M. Gladis, PhD; Laurel L. Brown, PhD; Robert Gallop, PhD. Arch Gen Psychiatry. 2005;62:409-416.

Cognitive Therapy Versus Medications In Moderate to Severe Depression
Prevention of Relapse Following Cognitive Therapy vs Medications in Moderate to Severe Depression. Steven D. Hollon, PhD; Robert J. DeRubeis, PhD; Richard C. Shelton, MD; Jay D. Amsterdam, MD; Ronald M. Salomon, MD; John P. O’Reardon, MD; Margaret L. Lovett, MEd; Paula R. Young, PhD; Kirsten L. Haman, PhD; Brent B. Freeman, BA; Robert Gallop, PhD. Arch Gen Psychiatry. 2005;62:417-422.