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How drugs stack up against talk therapy for the treatment of depression BY HAL ARKOWITZ AND SCOTT O. LILIENFELD IMAGINE a treatment for depression that possesses the following proper-ties: It is as effective as antidepressant medications but lacks their side ef-fects. Its therapeutic results last longer than those of antidepressant medi-cations after treatment has ended. Its benefits generalize to many do-mains of life. It causes changes in the brain in processes associated with depression. It usually needs to be ad-ministered only once a week. It gener-ally costs the same or less than medi-cations. Sound too good to be true? In fact, such a treatment has been around for decades, although many people do not know about it. It is they signal a significant risk factor for scribed class today: SSRIs, or selective other antidepressants) before they find serotonin reuptake inhibitors [see box side effects. Studies find that about 50 Imagine a treatment for depression that is as effective as antidepressant medications but lacks their side effects.
Some studies have shown that combining psychotherapy and medications is more effective than either alone for adults.
not been shown to be effective for chil- [see box below]. In the remainder of entific American Mind, August/September 2007]. In addition, antide-pressants can cause fetal damage, so Selective serotonin reuptake inhibitors, or SSRIs, can relieve depression >> Short-term (lasting a few weeks): in practice. The researchers presented depressed patients with a four-step set of options to be used if necessary. All subjects started on the same anti- Scientists have evaluated only a few types of psychotherapy. The most supporting data exist for cognitive-behavior therapy and interpersonal psycho- therapy, which have been shown to be effective in treating depression. Only a few studies have examined the performance of the other three therapies listed below, but their outcomes are encouraging.
which included changing medication, adding medication, or adding or Interpersonal psychotherapy Focuses on the social difficulties and medications is more effective than ei-ther treatment alone. Further, several relapse at twice the rate of those treat- therapists often switch strategies if the Psychotherapy and the Brain Drug company marketing suggests that depression must be caused by that imbalance. Inferring causality from is caused by a “chemical imbalance” in the brain. the success of a treatment is frequently a flawed endeavor: For example, an advertisement by the maker of the aspirin is effective for headaches, but no one would selective serotonin reuptake inhibitor (SSRI) Zoloft states: seriously claim that headaches are caused by a deficiency “While the cause is unknown, PET images of a patient with obsessive-compulsive dis- Such advertising is mislead- order before (left) and after (right) successful psycho- ing, however, and does not therapy show decreases in glucose metabolic rates. reflect scientific findings. Such brain changes have also been found in depressed There is no clear scientific patients who have received therapy.
ter deficits cause depression or that there is an optimal lated to rumination, a common feature of depression. “balance” of neurotransmitter levels in the brain. More- Some studies have found brain changes identical to those over, medications that primarily affect chemical messen- caused by antidepressant medications, whereas others gers other than serotonin are as effective as SSRIs. have found different brain changes. These findings sup- Undoubtedly, antidepressants are helpful in alleviating port the idea that psychotherapy produces measurable depression. But there is a form of circular reasoning that changes in the brain, although these modifications may goes: if SSRIs are helpful in alleviating depression, and if sometimes differ from those produced by medication.
they do change the “chemical imbalance,” then depression to half the relapse rate of drug therapy chotherapies have proved beneficial. In pression [see box on opposite page]. Many studies have shown significant brain changes in patients treated with psychotherapy alone.
serve on the board of advisers for Scientific American Mind. Arkowitz is a psychology professor at the University of Arizona, and Lilienfeld is a psychology professor at Emory authors thank Steve Hollon of Vanderbilt University for his invaluable help with this column. Any statements made in the column, however, are solely the responsibility of the at around two thirds. This means that many people are helped but are left with some depressive symptoms, whereas others are not helped at all. ◆ Psychotherapy and Medication in the Treatment of Adult and Geriatric Depression: Which Monotherapy or Combined Treatment? S. D. Hollon, R. B. Jarrett, A. A. Nieren-berg, M. E. Thase, M. Trivedi and A. J. Rush in Journal of Clinical Psychiatry, Vol. 66, ◆ The Empirical Status of Cognitive-Behavioral Therapy: A Review of Meta-analyses. A. C. Butler, J. E. Chapman, E. M. Forman and A. T. Beck in Clinical Psychology Review, Vol. 26, No. 1, pages 17–31; 2006.

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