NASHVILLE, Tenn. ó Research at Vanderbilt University and the University
of Pennsylvania challenges the American Psychiatric Association‘s
position that antidepressant medications are the only effective
treatment for moderately to severely depressed patients.
The research, published April 5 in two companion pieces in the Archives
of General Psychiatry, found that cognitive therapy, which teaches
patients new ways of thinking about their problems and emotions, may be
as effective at treating moderate to severe depression as
antidepressants, and more effective at preventing relapses following
treatment termination.
The researchers had presented their findings previously at a May 2002
meeting of the American Psychiatric Association in Philadelphia. This
publication formalizes the challenge to the American Psychiatric
Association‘s guidelines.
“For non-psychotic disorders, our findings lead us to disagree with the
American Psychiatric Association‘s guidelines,” Steve Hollon, an author
of the study, said. “Medication may not always be necessary. Our
findings suggest that you can do virtually anything with cognitive
behavioral therapy that you can do with medications, with the added
benefit that therapy might be longer lasting.”
Hollon is a professor of psychology and psychiatry at Vanderbilt and a
member of the Vanderbilt Kennedy Center for Research on Human
Development and the Center for Integrative and Cognitive Neuroscience.
He and his colleague Dr. Richard Shelton, professor of psychology and
psychiatry and a Kennedy Center member, led the Vanderbilt arm of the
study. Drs. Robert DeRubeis and Jay Amsterdam led the Pennsylvania arm
of the study.
“Cognitive therapy teaches patients how to monitor their own reactions
and helps them make sense of their own experiences,” Hollon said. “They
walk out of the door with those skills, which help protect them from
falling prey to helpless feelings.”
The research‘s publication comes at a time when antidepressant use is
skyrocketing in the United States, and the safety and efficacy for some
groups such as children and teenagers is being sharply questioned.
The acute treatment portion of the study compared the efficacy of
cognitive therapy, anti-depressants or placebos in patients
experiencing moderate to severe depression. Cognitive therapy is a form
of psychotherapy that helps patients identify negative underlying
beliefs, develop and practice thinking more accurately, and anticipate
potential problems and their solutions before they occur. The
Vanderbilt/Penn study was the largest study yet to focus exclusively on
patients with moderate to severe depression.
The studies took place simultaneously at Vanderbilt University in
Nashville, Tenn., and at the University of Pennsylvania in
Philadelphia. Two hundred forty patients participated.
In the initial portion of the study, patients were randomly divided
into three groups to receive either cognitive therapy, antidepressant
medication or a placebo. Those in the antidepressant group were given
paroxetine, commonly known as Paxil. Some patients were also given
lithium or desipramine if their symptoms warranted it.
After 16 weeks, 58 percent of both the antidepressant and the cognitive
therapy groups responded to treatment, with 46 percent of the
medication group and 40 percent of the therapy group seeing their
depression go into full remission. The researchers concluded that
cognitive therapy is statistically as effective as antidepressants at
treating depression.
The goal of the second portion of the study was to determine the
lasting effects, if any, of cognitive therapy and antidepressants once
treatment is halted.
This second portion of the study followed those 104 patients who had
responded well to either cognitive therapy or antidepressants during
the acute treatment phase for 24 months. A total of 88 patients stayed
with the process for the entire span of the study.
The researchers found the patients who had previously received
cognitive therapy were much less likely to relapse than those who had
been prescribed medication after treatment was haltedó76 percent of the
antidepressant group experienced a relapse, compared to just 31 percent
of the cognitive therapy group following treatment termination. The
researchers also found that previous cognitive therapy was at least as
effective at preventing relapse as ongoing antidepressant medicationó47
percent of those patients continuing antidepressant therapy experienced
a relapse. These findings suggest that cognitive therapy has an
enduring effect, something that has not yet been shown for other types
of psychotherapies, whereas medications are efficacious only as long as
you continue to take them.
The work was supported by a grant from the National Institutes of Health. GlaxoSmithKline provided medication and placebos.
For more news from Vanderbilt, visit http://www.vanderbilt.edu/news.
Media contact: Melanie Catania, (615) 322-NEWS
melanie.moran@vanderbilt.edu