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Home » Psychotherapy and Medication Roughly Comparable in Treating Depression

Psychotherapy and Medication Roughly Comparable in Treating Depression

November 1, 2008
From The Carlat Psychiatry Report
Issue Links: Learning Objectives | Editorial Information | PDF of Issue
Section editor, Glen Spielmans, PhD

Two recent meta-analyses examinedthe comparative efficacy of antidepressants versus psychotherapy in the treatment of depression and dysthymia (Cuijpers P et al., J Clin Psychiatry 2008, online ahead of print; Imel et al., J Affect Dis 2008;110:197- 206). In the acute treatment of depression, both reviews found that psychotherapyand medication did not differ in efficacy, although Cuijpers et al. found SSRIs superior to psychotherapy by a statistically significant but very small margin. In both reviews, medication was statistically significantly better than psychotherapy in treating dysthymia by a moderate effect size. Medication was linked to a significantly higher dropout rate than psychotherapy in the Cuijpers review. In studies that discontinued both treatments after a brief trial, psychotherapy led to longer term post-treatment gains than medication. Imel et al. also found that psychotherapy discontinued after an acute trial was as effective as medication continued in the longer-term, suggesting a prophylactic effect of short-term psychotherapy in reducing future episodes of depression.

TCPR’s Take: The general short- term equivalence of antidepressants and psychotherapy is in line with prior research, but some findings were surprising, particu- larly the notable superiority of medication in the treatment of dysthymia and the equivalence of short-term psychotherapy to longer-term medication treatment. The superiority for SSRIs over psychotherapyin the acute treatment of depression is interesting, but of questionable clinical significance given the very small difference in outcomes.

General Psychiatry
KEYWORDS depressive_disorder
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    Issue Date: November 1, 2008
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    Table Of Contents
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