Meds vs Therapy to Prevent Return of Depression

Depression relapse rates the same in study of medications and cognitive counseling

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Prescription medication and cognitive therapy are common treatments for individuals battling depression. Both of these treatments aim to help a depressed person get rid of negative thoughts over the long haul.

Cognitive therapy did relieve depression in some patients, according to a new study.

But after therapy ended, depression returned at roughly the same rate, whether a patient was taking the antidepressant fluoxetine or continued to undergo cognitive therapy, the study concluded.

"Ask your doctor about treatments for depression."

Robin B. Jarrett, PhD, of the University of Texas Southwestern Medical Center in Dallas, was lead author of this study.

For this research, a total of 523 adult patients from Dr. Jarrett's campus and the University of Pittsburgh Medical Center who were at high risk for suffering from repeated bouts of serious depression underwent 12 weeks of what is known as acute cognitive therapy. That involved between 16 and 20 individual sessions with trained therapists that lasted between 50 and 60 minutes.  

Among other tools, cognitive therapy requires patients to write down their bad thoughts, draw the link between their thoughts and behavior and then try to change both to reduce depression.

At the end of those 12 weeks, 241 patients continued the trial for further study. Eighty-six participants continued undergoing only cognitive therapy for eight months longer. An additional 86 study subjects only took fluoxetine (Prozac) for eight months. And 69 study subjects took only a placebo pill containing no medicine for those additional eight months.

After the eight months of treatment ended, the researchers found that 18 percent of those taking fluoxetine and 18.3 percent of those only undergoing cognitive therapy had relapsed back into depression. Of those taking the placebo, 32.7 percent had relapsed at the end of the eight months.

"As predicted, the patients who received either active therapy had a significantly lower risk of relapse...than did those who received [placebo] over eight months," the researchers wrote. "Contrary to prediction, we found no evidence to support the hypothesis that [cognitive therapy] conveys more enduring [protection against depression]...than fluoxetine..."

Regarding the study, Peter Strong, PhD, a Professional Psychotherapist, Online Therapist, Specialist in Mindfulness Therapy for Anxiety & Depression, and Author of The Path of Mindfulness Meditation, told dailyRx News, "This study shows, as do many other studies, that a cognitive-based therapeutic approach can be equally effective as drug-based interventions, but with significantly fewer side effects."

"However," Dr. Strong continued, "for cognitive therapy to produce a lasting effect it must address and significantly neutralize the underlying emotional formations that produce cognitive reactivity. This current study suggests that the form of cognitive therapy used in this study was not able to do this any better than medication alone."

After the eight months of taking antidepressants or a placebo, or being in cognitive therapy, 181 of the 241 adults signed up to be monitored by researchers for two more years. During that period, relapse rates continued to climb about equally between those in cognitive therapy and those only taking antidepressants. At the 20-month mark, 35 percent of patients in both groups had relapsed.

The researchers wrote that most of the study participants were white women in their 40s.

This research was published online September 4 in JAMA Psychiatry.

The National Institute of Mental Health and Eli Lilly, a prescription drugmaker, funded the study.

Review Date: 
September 4, 2013
Last Updated:
September 5, 2013