Therapy and Antidepressants Work Better Together Than Just Pills Alone

Depression is a tricky, often very individual disease, which can have both physical and psychological symptoms. New research out on Wednesday shows that patients with the most common kind of depression—meaning episodes of being low as opposed to chronic depression, which can last years—recovered better if they were treated with both cognitive therapy and antidepressants, compared to people who only received drugs.

“We think antidepressants work from the bottom up on the brain, smoothing hyperactivity in the area near the brain stem where emotions are generated. And cognitive therapy may work from the top down in the frontal cortex. You learn you’re more controlled than you thought you were,” says study author Steven Hollon, a professor of psychiatry at Vanderbilt University.

In the study, which was published in JAMA Psychiatry, the researchers studied 452 depressed adults at three medical centers in the U.S. who were randomly assigned to either treatment with antidepressants, or antidepressants with cognitive therapy. While many clinical trials of depressed patients are for a fixed period of time, in this study, the end point was recovery—meaning the patients experiences 6 full months without symptoms of depression. The group who had therapy and drugs fared better.

The researchers say the impetus for the study is a growing consensus that patients with depression need more than just their symptoms treated. In a corresponding editorial, Dr. Michael Thase, a professor of psychiatry at the University of Pennsylvania, said finding treatment options for people who do not respond to conventional methods is a top research priority. “There is no debate about whether cognitive therapy should be thought of as a first-line option, but what should a psychotherapist do when it doesn’t work?” he asks.

Beyond cognitive therapy and antidepressants, Thase, among others, wants more research into the efficacy of methods like mindfulness, interpersonal psychotherapy, and dialectical behavior therapy.