Medication for severe depression may be necessary, but it alone is not considered to be more effective than treating severely depressed patients with cognitive behavioral therapy (cognitive behavior therapy) in combination with the appropriate antidepressant medication. Previous studies have shown psychotherapy to be just as effective as antidepressants in treating mild to moderate forms of depression. However, we do not know as much about the efficacy of treating cases of severe depression with psychotherapeutic methods as opposed to medication. Despite this, many practice guidelines for the treatment of depression imply that medication for severe depression should be used rather than psychotherapy for cases of major depression. This study, however, discovered that patients suffering from more severe forms of depression were no more likely to benefit from antidepressants to feel better than patients suffering with less severe forms of depression.

The American Psychiatric Association (APA) along with the British Association for Psychopharmacology both suggest in their guidelines that although psychotherapy can be effective in the treatment of mild depression, medication for severe depression should be prescribed to treat cases of severe depression when the patient has been diagnosed with major depression. These guidelines were largely based on the results derived from a NIMH randomized control trial (RCT). The problem is that this recent analysis shows that the difference in outcomes seen in the NIMH trial were not seen in a number of RCTs conducted by others looking at medication being used in the treatment of acute-phase depression.

Although previous studies have tried to compare antidepressant medications and cognitive behavior therapy for treating depression, this recent study is different in that researchers obtained patient-level data, which helped them to look at individual outcomes. There were 16 studies that were reviewed, which offered patient-level data on individuals and 8 studies that did not. In total, the sample studied had data on a 1,700 patients. They used 1 of 2 well-established measures of depression in their analyses.

In all, 1,302 patients met the criteria for a diagnosis of severe depression. There was a mean age of 37.38 among the participants, with 69% being female, 43% being married, and 52% had full-time jobs. Among participants, 90% had 12 years of schooling (equivalent to a high school education), with 65% having more education.

In patients suffering from severe depression, the analysis of those being treated with antidepressant medication showed no significant difference in their response to treatment than patients being treated with cognitive behavior therapy. The results showed that 63% of patients receiving antidepressant medication and 58% of patients receiving cognitive behavior therapy did respond to treatment with 51% of antidepressant medication patients and 47% of cognitive behavior therapy patients meeting the criteria for remission. Patients suffering from more severe forms of depression were no more apt to need antidepressant medication to feel better than patients suffering from less severe forms of depression, and even more surprising, these results were robust. Furthermore, in analyzing the more severe patients, there was no differential response to treatment between cognitive behavior therapy and antidepressant medication. Hence, cognitive behavior therapy might be considered and effective first-line of treatment for these particular patients.

Whereas the guidelines suggest that medication for severe depression is needed, there is not enough data to recommend antidepressant medication rather than cognitive behavior therapy in outpatients simply based on severity of symptoms. The results do suggest that cognitive behavior therapy might be an effective first-line of treatment for patients suffering from severe depression.

In our intensive outpatient program for depression, we provide access to both cognitive behavior therapy and antidepressant medication in an effort to maximize the chances for a successful outcome.  You can see here that our treatment for depression is highly successful.  If you are experiencing symptoms of severe depression, call us now to schedule an assessment.

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