Cognitive therapy versus medication for depression: treatment outcomes and neural mechanisms

Summary & key facts

This review looked at many studies comparing cognitive therapy (a type of talking therapy that teaches people to spot and test negative thoughts) with antidepressant medication for unipolar depression. Both treatments work about equally well at easing a current episode of depression. But cognitive therapy seems to lower the chance that depression comes back after treatment stops, while medication usually protects only while you keep taking it. Brain studies show that the two treatments change some of the same brain systems and some different ones, but scientists do not yet know exactly how those brain changes link to lasting recovery.

Key facts:

• About 13 to 14 million adults in the United States have depression each year, and roughly 1 in 6 people experience it at some point in their life.
• Many studies show that cognitive therapy and antidepressant medication are about equally effective at reducing symptoms during an episode of unipolar depression.
• Cognitive therapy appears to lower the risk that depression will return after treatment ends, while antidepressant medication usually reduces symptoms only while it is being taken.
• Antidepressant medications affect brain chemical systems such as serotonin, noradrenaline and dopamine and change activity in emotion-related brain areas like the amygdala and hippocampus.
• Cognitive therapy teaches skills: noticing upsetting thoughts, stepping back from those thoughts, testing whether the thoughts are true, and finding repeating thought patterns across situations.
• Research comparing how the two treatments change the brain suggests they share some neural effects and also have distinct effects, but the exact brain mechanisms that cause lasting benefit are not yet fully defined.
• Not all studies agree on every point. For example, a major trial found different results for people who started treatment with very severe depression, showing that outcomes can depend on factors like initial severity.
• About half of people respond to any single antidepressant drug, and others may respond to a different drug or to combinations of drugs.

Topics

Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Functional Brain Connectivity Studies Treatment of Major Depression

Categories

Health Sciences Medicine Pharmacology

Tags

Antidepressant Antidepressant medication Anxiety Clinical psychology Cognition Cognitive therapy Depression (economics) Discontinuation Economics Macroeconomics Medicine Psychiatry Psychology Psychotherapist

Conditions & symptoms

Anxiety Depression Lack of energy or motivation Poor appetite or overeating Poor sleep Sadness or low mood