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How drugs stack up against talk therapy for the treatment of depression BY HAL ARKOWITZ AND SCOTT O. LILIENFELD
IMAGINE a treatment for depression that possesses the following proper-ties: It is as effective as antidepressant medications but lacks their side ef-fects. Its therapeutic results last longer than those of antidepressant medi-cations after treatment has ended. Its beneﬁts generalize to many do-mains of life. It causes changes in the brain in processes associated with depression. It usually needs to be ad-ministered only once a week. It gener-ally costs the same or less than medi-cations. Sound too good to be true? In fact, such a treatment has been around for decades, although many people do not know about it. It is
they signal a signiﬁcant risk factor for
scribed class today: SSRIs, or selective
other antidepressants) before they ﬁnd
serotonin reuptake inhibitors [see box
side effects. Studies ﬁnd that about 50
Imagine a treatment for depression that is as effective as
antidepressant medications but lacks their side effects.
Some studies have shown that combining psychotherapy and
medications is more effective than either alone for adults.
been shown to be effective for chil-
[see box below
]. In the remainder of
entiﬁc American Mind, August/September 2007]. In addition, antide-pressants can cause fetal damage, so
Selective serotonin reuptake inhibitors, or SSRIs, can relieve depression
>> Short-term (lasting a few weeks):
in practice. The researchers presented depressed patients with a four-step set of options to be used if necessary. All subjects started on the same anti-
Scientists have evaluated only a few types of psychotherapy. The most
supporting data exist for cognitive-behavior therapy and interpersonal psycho-
therapy, which have been shown to be effective in treating depression. Only
a few studies have examined the performance of the other three therapies
listed below, but their outcomes are encouraging.
which included changing medication, adding medication, or adding or
Interpersonal psychotherapy Focuses on the social difﬁculties and
medications is more effective than ei-ther treatment alone. Further, several
relapse at twice
the rate of those treat-
therapists often switch strategies if the
Psychotherapy and the Brain Drug company marketing suggests that depression must be caused by that imbalance. Inferring causality from
is caused by a “chemical imbalance” in the brain. the success of a treatment is frequently a ﬂawed endeavor: For example, an advertisement by the maker of the aspirin is effective for headaches, but no one would
selective serotonin reuptake inhibitor (SSRI) Zoloft states: seriously claim that headaches are caused by a deﬁciency “While the cause is unknown,
PET images of a patient with obsessive-compulsive dis-
Such advertising is mislead- order before (left
) and after (right
) successful psycho-
ing, however, and does not
therapy show decreases in glucose metabolic rates.
reflect scientific findings. Such brain changes have also been found in depressed
There is no clear scientiﬁc patients who have received therapy.
ter deﬁcits cause depression or that there is an optimal lated to rumination, a common feature of depression.
“balance” of neurotransmitter levels in the brain. More-
Some studies have found brain changes identical to those
over, medications that primarily affect chemical messen-
caused by antidepressant medications, whereas others
gers other than serotonin are as effective as SSRIs.
have found different brain changes. These ﬁndings sup-
Undoubtedly, antidepressants are helpful in alleviating port the idea that psychotherapy produces measurable
depression. But there is a form of circular reasoning that changes in the brain, although these modiﬁcations may
goes: if SSRIs are helpful in alleviating depression, and if sometimes differ from those produced by medication.
they do change the “chemical imbalance,” then depression
to half the relapse rate of drug therapy
chotherapies have proved beneﬁcial. In
pression [see box on opposite page
Many studies have shown signiﬁcant brain changes in
patients treated with psychotherapy alone.
serve on the board of advisers for Scientiﬁc
Arkowitz is a psychology
professor at the University of Arizona, and
Lilienfeld is a psychology professor at Emory
authors thank Steve Hollon of Vanderbilt
University for his invaluable help with this
column. Any statements made in the column,
however, are solely the responsibility of the
at around two thirds. This means that many people are helped but are left
with some depressive symptoms, whereas others are not helped at all.
◆ Psychotherapy and Medication in the Treatment of Adult and Geriatric Depression:
Which Monotherapy or Combined Treatment? S. D. Hollon, R. B. Jarrett, A. A. Nieren-berg, M. E. Thase, M. Trivedi and A. J. Rush in Journal of Clinical Psychiatry,
◆ The Empirical Status of Cognitive-Behavioral Therapy: A Review of Meta-analyses.
A. C. Butler, J. E. Chapman, E. M. Forman and A. T. Beck in Clinical Psychology Review,
Vol. 26, No. 1, pages 17–31; 2006.
Veterinary Microbiology 134 (2009) 305–310j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / v e t m i cIn vitro antimicrobial activity against 10 North American and EuropeanLawsonia intracellularis isolatesSuphot Wattanaphansak Randall S. Singer Connie J. Gebhart a Department of Veterinary and Biomedical Sciences, College of Veterinary Medicine, University o
CURRICULUM VITAE Hans Annell Illustratör/informationsdesigner, civilingenjör Född 1969 070-660 94 26 PRESENTATION Jag är högskoleutbildad illustratör och har dessutom en flerårig erfarenhet som teknisk skribent. I grunden är jag civilingenjör. Jag är van att analysera och strukturera komplicerade förlopp. Med min bakgrund som ingenjör och teknisk skribent, i kombina