Although we harp on this at least once every few months, it bears repeating:
Psychotherapy with medication is usually the best possible treatment option for depression (acute or chronic) for nearly everyone. If you’re only doing one or the other, you’re likely not going to get well as quickly, it’s that simple. We have decades’ worth of research showing this, but here’s another one to add to the pile.
Manber and colleagues (2008) re-examined previous data on 656 patients with chronic depression to see who would get to remission first. Remission in depression research is simply when a person’s depression score on a commonly used depression quiz (the Hamilton) falls below a certain number.
People who had scores of less than 26 on the Hamilton fared best with the combination treatment — 40% of them attained ‘full remission’ within the 12 week study period. So in just 3 months of combined treatment, your depressive feelings could be significantly decreased.
Neither psychotherapy alone nor medication alone significantly differed from one another in terms of their effectiveness in helping a person with depression in this study — they were both equally effective. However, the researchers discovered that neither treatment by itself was as effective as the combination of the two.
Some people with chronic depression give up on one or the other modality at some point in treatment. After going to therapy for years, for instance, one can certainly get a feeling that continuing it is of little use if you haven’t felt less depressed. The same is true if you’ve been taking the same antidepressant for years and find it only seems to help a little.
Combination treatment may not help in every situation or with every person. But it is the treatment of choice for virtually everyone to try, especially if this is their first time experiencing depression.
Reference:
Manber R, Kraemer HC, Arnow BA, Trivedi MH, Rush AJ, Thase ME, Rothbaum BO, Klein DN, Kocsis JH, Gelenberg AJ, Keller ME. (2008). Faster remission of chronic depression with combined psychotherapy and medication than with each therapy alone. J Consult Clin Psychol., 76(3):459-67.
(4 votes, average: 5 out of 5)
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11 Responses to “Psychotherapy + Meds for Chronic Depression” (Pingbacks/trackbacks not shown below)
Wendy Aron at 10:13 am on
August 7th, 2008
It also helps if your psychiatrist and therapist have worked together and can check in with each other about your condition.
Wendy Aron, author of Hide & Seek: How I Laughed at Depression, Conquered My Fears and Found Happiness
http://www.wendyaron.com
David Fetrow at 7:51 pm on
August 7th, 2008
I just think doctors prescribe the medication way to fast. What makes it worse is they do not set them up with a plan to get them off of it. We are a pill happy society. It is only getting worse.
John M. Grohol, Psy.D. at 6:42 am on
August 8th, 2008
Wendy makes a point worth noting — a team of professionals that work together (even in the same office suite!) can be invaluable.
David, I agree, but it’s a chicken and egg problem. Docs offer the treatments that people most want — meds are easy, perceived as being “quick” (because you start taking them immediately, even though most people won’t start to feel an antidepressants’ beneficial effects for 4 to 6 weeks), and don’t require any behavioral or cognitive changes in the person. They can just keep being “themselves,” even though that person is depressed.
I think part of that is still due to misconceptions about what modern therapy is, how quickly it can work in the hands of an experienced therapist, and why sometimes changes in our lives are actually good things.
therapyfirst at 7:38 pm on
August 10th, 2008
Yeah, we as mental health care providers know this, but what good does it do when 70% of antidepressants are written by non-psychiatrists like family MDs/PCPs who just sell the quick fix mentality by writing a script and doing the follow up 9 out of 10 times. I know as I see it every day in my office: “my doctor sent me to you as the meds he wrote (usually more than one trial of meds) didn’t work and now I need to see a specialist to get the right combination.” Oh great, now we need to consider polypharmacy!
Managed care is the ultimate villian here, folks. They pushed out psychiatrists as therapy providers, shoved social workers, too many without true therapy training, as substitutes, kept chipping away at the reimbursement rates, reimburse more for medication follow up visits to encourage 10-15 minute visits by psychiatrists, and now don’t even reimburse fairly for them to do an evaluation in the first place.
You want a quick fix? Go to the Hotel Inpatient Psych unit and claim you are suicidal so they can put you on meds, high doses usually, and you’ll feel better fast. Oh, that’s right, what about the fact that you’re in a place that gives you 24 hr attention and insulates you from your stressors. Not a pill, is it?
These stories are nice, until you put them down and return to reality. Therapy is needed, but never valued.
It is a shame psychiatrists never banded together and sold that message.
therapyfirst
(board certified psychiatrist)
therapyfirst at 10:12 am on
August 13th, 2008
as an addendum to my above comment, this was in the Aug 08 Current Psychiatry journal (www.CurrentPsychiatry.com)letters to editor by Craig Heacock, MD from Fort Collins, CO, which said:
(responding to list by editor of journal of listing challenges to psychiatry)…[not on the list]: psychiatrists doing med checks and ignoring psychotherapy. This trend is bad for patients and psychiatrists. Our relationship with patients is what allows healing to begin. Medications are fertilizer for the barren soil, and psychotherapy is the hard work of planting and tending the fields. We kid ourselves when we think medications are going to “fix” people.
Love the analogy, couldn’t say it any better than that. As long as we live in a quick fix culture and do not challenge this self defeating mindset, providers sell out their patients by offering meds alone.
Don’t believe me, see the lack of results from those who jump from pill to pill.
therapyfirst (psychiatrist)
Yes, I can tell you that I have been through the mill will pills and psycotherapy. I have tried to commit suicide three times in the last three years. I have been hospitilized twice with a week duration for each. I am still seeing a pscyhiatrists who has taken me off antidepressents the last year. I think mostly because I overdose on them. She says I have chronic depression, acutally have been dianosed with just about every kind of mood disorder in the past ten years. My concern is I am always feeling so down, I want to snap out of it but its like a ball and chain holding me down and I can’t move forward. Right now I am in tears at work knowing I have to get through another day and put on that happy face. I have come to the conclusion that if I can’t contribute something postitive to this planet than I would be better for all concerned to remove myself from such. The sad thing about all this is that suffering depression is not well received in our society. My family has rejected me, my daughter who is pregnant and will make me a granny in January, she too will not talk to me. So, yes I don’t handle rejection very well and feel why is it I have to be punished by society because I have this desease. I don’t think society will ever accept this illness and I feel for those pool souls who get lost in the cracks of the health system and are considered losers on this planet. I wish someone could event a “big pill” that would allow one to leave this world without it being a disgrace and embarrassment to all concerned. Hell we put our pets down , they simply go with grace and dignity intact. Something wrong with this whole picture.
Linda said just about everything I want to say, except for me therapy & meds have pretty much taken away my ability to wish for suicide. I’m still not sure whether that’s a good thing.
Prior to three months ago, I’d been in treatment for two years and I thought I as doing a lot better, but it seems as though I’ve lost so much ground.
Erica, glad you read my memo. But hang in there, it is such a long hard battle to climb back up there and sustain a “normal”, balance. My Doctor shuns at me when I use that word “normal”. As long as you are no longer suicidal then be greatful for that. Sounds like you are going to be okay, just stay on the meds and therapy. I wish that meds had worked for me because everyday is a struggle to stay alive. I wish you well. Linda
Erica, glad you read my memo. But hang in there, it is such a long hard battle to climb back up there and sustain a “normal”, balance. My Doctor shuns at me when I use that word “normal”. As long as you are no longer suicidal then be greatful for that. Sounds like you are going to be okay, just stay on the meds and therapy. I wish that meds had worked for me because everyday is a struggle to stay alive. I wish you well. Linda
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It also helps if your psychiatrist and therapist have worked together and can check in with each other about your condition.
Wendy Aron, author of Hide & Seek: How I Laughed at Depression, Conquered My Fears and Found Happiness
http://www.wendyaron.com
I just think doctors prescribe the medication way to fast. What makes it worse is they do not set them up with a plan to get them off of it. We are a pill happy society. It is only getting worse.
Wendy makes a point worth noting — a team of professionals that work together (even in the same office suite!) can be invaluable.
David, I agree, but it’s a chicken and egg problem. Docs offer the treatments that people most want — meds are easy, perceived as being “quick” (because you start taking them immediately, even though most people won’t start to feel an antidepressants’ beneficial effects for 4 to 6 weeks), and don’t require any behavioral or cognitive changes in the person. They can just keep being “themselves,” even though that person is depressed.
I think part of that is still due to misconceptions about what modern therapy is, how quickly it can work in the hands of an experienced therapist, and why sometimes changes in our lives are actually good things.
Yeah, we as mental health care providers know this, but what good does it do when 70% of antidepressants are written by non-psychiatrists like family MDs/PCPs who just sell the quick fix mentality by writing a script and doing the follow up 9 out of 10 times. I know as I see it every day in my office: “my doctor sent me to you as the meds he wrote (usually more than one trial of meds) didn’t work and now I need to see a specialist to get the right combination.” Oh great, now we need to consider polypharmacy!
Managed care is the ultimate villian here, folks. They pushed out psychiatrists as therapy providers, shoved social workers, too many without true therapy training, as substitutes, kept chipping away at the reimbursement rates, reimburse more for medication follow up visits to encourage 10-15 minute visits by psychiatrists, and now don’t even reimburse fairly for them to do an evaluation in the first place.
You want a quick fix? Go to the Hotel Inpatient Psych unit and claim you are suicidal so they can put you on meds, high doses usually, and you’ll feel better fast. Oh, that’s right, what about the fact that you’re in a place that gives you 24 hr attention and insulates you from your stressors. Not a pill, is it?
These stories are nice, until you put them down and return to reality. Therapy is needed, but never valued.
It is a shame psychiatrists never banded together and sold that message.
therapyfirst
(board certified psychiatrist)
as an addendum to my above comment, this was in the Aug 08 Current Psychiatry journal (www.CurrentPsychiatry.com)letters to editor by Craig Heacock, MD from Fort Collins, CO, which said:
(responding to list by editor of journal of listing challenges to psychiatry)…[not on the list]: psychiatrists doing med checks and ignoring psychotherapy. This trend is bad for patients and psychiatrists. Our relationship with patients is what allows healing to begin. Medications are fertilizer for the barren soil, and psychotherapy is the hard work of planting and tending the fields. We kid ourselves when we think medications are going to “fix” people.
Love the analogy, couldn’t say it any better than that. As long as we live in a quick fix culture and do not challenge this self defeating mindset, providers sell out their patients by offering meds alone.
Don’t believe me, see the lack of results from those who jump from pill to pill.
therapyfirst (psychiatrist)
Yes, I can tell you that I have been through the mill will pills and psycotherapy. I have tried to commit suicide three times in the last three years. I have been hospitilized twice with a week duration for each. I am still seeing a pscyhiatrists who has taken me off antidepressents the last year. I think mostly because I overdose on them. She says I have chronic depression, acutally have been dianosed with just about every kind of mood disorder in the past ten years. My concern is I am always feeling so down, I want to snap out of it but its like a ball and chain holding me down and I can’t move forward. Right now I am in tears at work knowing I have to get through another day and put on that happy face. I have come to the conclusion that if I can’t contribute something postitive to this planet than I would be better for all concerned to remove myself from such. The sad thing about all this is that suffering depression is not well received in our society. My family has rejected me, my daughter who is pregnant and will make me a granny in January, she too will not talk to me. So, yes I don’t handle rejection very well and feel why is it I have to be punished by society because I have this desease. I don’t think society will ever accept this illness and I feel for those pool souls who get lost in the cracks of the health system and are considered losers on this planet. I wish someone could event a “big pill” that would allow one to leave this world without it being a disgrace and embarrassment to all concerned. Hell we put our pets down , they simply go with grace and dignity intact. Something wrong with this whole picture.
Linda said just about everything I want to say, except for me therapy & meds have pretty much taken away my ability to wish for suicide. I’m still not sure whether that’s a good thing.
Prior to three months ago, I’d been in treatment for two years and I thought I as doing a lot better, but it seems as though I’ve lost so much ground.
Erica, glad you read my memo. But hang in there, it is such a long hard battle to climb back up there and sustain a “normal”, balance. My Doctor shuns at me when I use that word “normal”. As long as you are no longer suicidal then be greatful for that. Sounds like you are going to be okay, just stay on the meds and therapy. I wish that meds had worked for me because everyday is a struggle to stay alive. I wish you well. Linda
Erica, glad you read my memo. But hang in there, it is such a long hard battle to climb back up there and sustain a “normal”, balance. My Doctor shuns at me when I use that word “normal”. As long as you are no longer suicidal then be greatful for that. Sounds like you are going to be okay, just stay on the meds and therapy. I wish that meds had worked for me because everyday is a struggle to stay alive. I wish you well. Linda
