Meds with therapy can lift severe depression

In North America, about one in five women and one in 10 men suffer from major depression in her or his lifetime. (Credit: Michael Tapp/Flickr)

Combining cognitive therapy with medication improves the odds by as much as 30 percent that a person suffering from severe, nonchronic depression will recover.

The same benefits don’t hold true for people with chronic or less severe depression, research shows.

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In North America, about one in five women and one in 10 men suffer from major depression in her or his lifetime.

“Our results indicate that combining cognitive therapy with antidepressant medicine can make a much bigger difference than we had thought to about one-third of patients suffering from major depressive disorder,” says Steven Hollon, professor of psychology at Vanderbilt University.

“On the other hand, it does not appear to provide any additional benefit for the other two-thirds.”

Previous studies have shown that about two-thirds of all patients with major depressive disorder will improve on antidepressant medications and about one-third of patients will achieve full remission, but half then relapse before fully recovering.

Cognitive therapy is about as effective as medication alone but its effects tend to be longer lasting. Combining the two has been estimated to improve recovery rates by 6 to 33 percent.

“Now, we have to reconsider our general rule of thumb that combining the two treatments keeps the benefits of both,” Hollon says.

Remission to recovery

Reported in JAMA Psychiatry, the study was a randomized clinical trial involving 452 adult outpatients with chronic or recurrent major depressive disorder. Unlike previous studies that followed subjects for a set period of time, this study treated them for as long as it took—first to remission (full normalization of symptoms)—and then to recovery (six months without relapse), which in some cases took as long as three years.

“This provided us with enough data so that we could drill down and see how the combined treatment was working for patients with different types and severity of depression: chronic, recurrent, severe, and moderate,” Hollon says.

The results could have a major impact on how major depressive disorder is treated. The most immediate effect is likely to be in the United Kingdom, which is 10 years ahead of the United States in treatment of depression, Hollon says.

The use of combined cognitive therapy and antidepressive medicine is standard for severe cases in the UK, and the English National Health Service is actively training its therapists in cognitive therapy and other empirically supported psychotherapies.

Researchers from University of Pennsylvania, University of New Mexico, Albuquerque, University of Alabama, Birmingham, Rush University, and West Chester University contributed to the study. The National Institute of Mental Health provided funding.

Source: Vanderbilt University