Are Psychopharmaca Superior to Psychotherapy in the Treatment of Depression?

Globally, major depressive disorder (MDD) is among the top five public health concerns today (Cuijpers et al., 2011; Jakobsen, Hansen, Simonsen, & Gluud, 2011; Hees, Rotter, Ellermann, & Evers, 2013). Moreover, almost 20% of patients with depression engage in self-harming behaviors, including suicidal attempts (Gamble et al., 2013; Jakobsen et al., 2011). Not only is the prevalence of depression alarming, but costly to the health care system (Cuijpers et al., 2011; Cuijpers et al., 2014; Hees et al., 2013; Jakobsen et al., 2011). The use of antidepressants is the standard for initial treatment, but may be limiting in preventing relapse (Cuijpers et al., 2014; Jakobsen et al., 2011). Therefore, the inclusion of non-pharmacological interventions may be necessary to improve treatment outcomes (Cuijpers et al., 2011; Dekker et al., 2013; Jakobsen et al., 2011). Interpersonal psychotherapy (IPT) and cognitive behavior therapy (CBT) are the two primary psychotherapeutic interventions recommended in the treatment of depression. In this paper, I will discuss the difference between CBT and IPT, compare the effectiveness between both therapies, explore their efficacy as an adjunct treatment with antidepressant medications, and summarize the treatment guidelines for depression.

Cognitive behavioral therapy (CBT) is a form of psychotherapy. The effectiveness has been researched extensively over the years (Dobson, 2001). There are over three hundred published studies about the outcomes of cognitive behavioral therapy interventions. The main reason for this is that an ongoing adaptation of this form of psychotherapy makes it applicable to a vast amount of disorders and related problems (Rounsaville & Caroll, 2002). Despite the relatively great amount of studies on the effectiveness of cognitive behavioral therapy, questions still remain about the levels of effectiveness for different disorders, about the effects of

Cognitive therapy is one of the few theories that have been extensively scientifically tested and found to be highly effective in over 300 clinical trials. It focuses on the immediate or automatic thoughts the client has and how these thoughts affect their feelings and behaviors. The goal of cognitive therapy is to identify these thoughts that are poorly affecting the client. Then teach the client how to identify these automatic thoughts and how they can effectively change them. Through the very structured sessions of cognitive therapy, a client should essentially learn the tools to be their own cognitive therapist for future problems they may encounter. The therapy session will not make them an expert but they will be better prepared to

Does cognitive-behavioral therapy work just as well as antidepressants when treating depression? How we perceive our depression is what helps to determine the type of treatment necessary. Antidepressants treat the common symptoms of depression rather than the condition while therapy helps change the thought process so the disease is cured in the end. Many studies are done to provide necessary information to what the answer to this question should be. The following articles provided studies that explained the effects of treatment with medication, with therapy, or a combination of both.

In this article, antidepressant medication (ADM) is described as the most commonly used treatment for severe depression and cognitive therapy (CT) is the most talked about treatment that could be used for severe depression. Although, some patients do not want to take ADMs daily and CT is still being studied as a treatment option for major depression disorder. There was another alternative therapy treatment that was being questioned, behavioral activation therapy. The primary objective of this study was to test the effectiveness of behavioral activation therapy towards adults with major depression disorder. For this study, behavioral activation was studied with cognitive therapy and antidepressant medications in a placebo controlled randomized

Treatments using anti-depressants is well documented, but there are very few studies documenting only the use of psychotherapy. However, in one study done using the Cognitive–behavioral analysis system of psychotherapy (CBASP) as a maintenance treatment, the overall findings show that psychotherapy in itself can be successful. “ There were 82 patients who were treated with CBASP long term. Patients were chosen at random to reduce their treatment to monthly or to an observational status. The patients, only treated monthly with CBASP, showed a smaller amount of reoccurring symptoms then the patients in the observational status. These findings support the use of only CBASP as a maintenance treatment for depression.” (Klein, 2004)

The foundation of cognitive therapy is that thoughts have the ability to influence individual's feelings. One's emotional

A probable reason why CBT works with depressed patients is that depression interacts with both cognitive and motivational processes. This is well evidenced in experimental analogue research with healthy and depressed individuals. Individuals with depression show deficits on a range of cognitive tests (Brown, Scott, Bench, 1994) with the pattern of dysfunction having many of the characteristics associated with fronto-subcortical impairment. Reischies and Neu (2000) found that depressed individuals displayed mild cognitive impairments in comparison with matched controls, particularly in the areas of "adverbial" memory, psychomotor speed and verbal fluency. Further in these patients there appears to be considerable variation in the recovery of cognitive function with remission of the depressive episode.

Lastly, according to the Archives of General Psychology (2003) , Cognitive Behavior therapy produces a different pattern of brain activity than SSRIs. The researchers scanned seventeen patients, who had not been treated for depression, before and after a session of Cognitive Behavioral Therapy. There was an improvement in the depression; the tomography disclosed that there was increased activity in the dorsal cingulate regions and hippocampus. These results were then compared to a set of participants with nearly the same intensities of depression before and after taking SSRIs. Scans showed changes in brain activity in the opposite direction, with increases in the prefrontal cortex and decreases in the hippocampus and dorsal cingulate regions.

A recent study examined the efficacy of treating patients with serotonin reuptake inhibitors (SSRIs) who are suffering from Major Depressive Disorder (MDD), or who are comorbid for MDD and Posttraumatic Stress Disorder (PTSD) (Sher et al., 2012). Even though SSRIs are recommended for treating these conditions, previous research findings suggested that SSRIs might be less effective for patients comorbid for MDD and PTSD. Several self-reporting instruments were used, including the Beck Depression Inventory (BDI). The BDI has been extensively tested since it was first designed by Aaron T. Beck in 1961, and has proven to be both valid and reliable (Encyclopedia of Medical Disorders, 2012).

In The Norwegian Naturalistic Treatment Study of Depression , scientists evaluated the efficacy of Cognitive Behavioral Therapy combined with antidepressants or a placebo. This was a randomized double blind study, meaning that the proctors/researchers, nor the patients knew whether they were a part of the placebo or experimental group. This double blind method provides less biased results, due to the lack of knowledge of both, the participants and the researchers. Approximately three hundred patients participated in this case study. The outcome, measured by both the patient and physician, showed that the combination of the SSRI and the Cognitive Behavioral Therapy was more effective than just the Cognitive Behavioral Therapy, especially towards

Major depressive disorder affects nearly 15 million of American adults in a given year. (Kessler, Chiu, Demler & Walters, 2005). With the impact it has on the society as well as the well-being of the individual, it must be in the interest of the healthcare to be able to provide patients with the most effective treatment method. Extensive research has been conducted on the efficacy of antidepressant medication and cognitive therapy, the two main treatment methods used for depression today. The discussion has, however, been characterized by conflicting claims, resulting in a debate over what should be used rather than us having definite conclusion of how patients are best helped.

Hook: The recognition of depression as a common mental illness should lead to studies regarding what form of treatment is best for a patient, but antidepressants seem to be the unimpressive go-to.

Cognitive Theory claims that behavior can be changed through changing faulty thinking, irrational thoughts, automatic thoughts, or learned cognitive misconceptions. When a client has negative images of themselves or their accomplishments, it sets the pace for their behavior, perceptions and expectations; when that thinking is exposed as faulty to the client, the client can then begin to change their behavior based upon restructured, truer images of reality. It has been shown to be effective therapy for individual, group, marital and family treatment, in treating depression, addiction, anxiety, PTSD, personality disorders, and some organic conditions such as schizophrenia, and in many social work settings, such as child welfare, private practice, mental health, crisis intervention, and health care.

al, 2012). It was also found that better outcomes occurred for patients that were younger with a lower baseline depression (Carpenter et. al, 2012). Studies have found improvement in cognitive functioning along with symptoms of depression. The improvement of depression symptoms was linked with an improvement in visuospatial memory, verbal memory, long-term memory recall, working memory, information processing speed, and orientation (Serafini et. al, 2015). It is predicted that the improvement in cognitive functioning occurs due to the relief of symptoms, but it is also postulated that the improvement of cognitive function improves depressive symptoms (Serafini et. al, 2015; Kedzior et. al, 2015). However, more research needs to be done to determine the temporal precedence and to better understand the cognitive improvement.