Therapy or Medication for Depression?

Peter ForsterMajor Depression, Treatments of Depression

Therapy or medication for depression? Which is more effective? When might you want to consider both treatments? These are among the most frequent questions that we are asked. A recent study published in JAMA Psychiatry provides the best information available about how to make this decision.

The study involved 452 patients who received antidepressant medication treatment for depression with or without cognitive therapy.

This is the largest study and the one with the longest follow up to evaluate this question.

In the study, clinicians could make multiple adjustments in the treatment regimen for almost two years in order to achieve remission. And the study continued for up to an additional 3 years with treatment designed to prevent relapse.

By and large the findings supported the “conventional wisdom” that combined treatment was more effective than just treatment with medication.

But the study identified two groups of patients who had limited benefit from the combination treatment – patients with milder depression, and patients which chronic depression. We will come back to the issue of patients with chronic depression.

For Mild Depression Choose One Approach

Patients with milder depression did not benefit from a combination of treatments, they should probably select one approach (medication or therapy).

One of the best ways of selecting a treatment approach is to make the choice based on what you think is most likely to work, talk to your doctor, of course, but your confidence in one or the other treatment approach is one of the best predictors of the results of treatment.

For Moderate or Severe Depression Combined Treatment is More Effective

As Michael Thase notes, in an accompanying editorial, the difference in outcomes for patients with moderate or severe depression, who had been depressed for less than two years, was very significant.

The 29% difference in recovery rates for patients with “more severe, nonchronic” major depression is a very large effect…

For Chronic Depression – Select Treatments Designed to Treat Chronic Depression

But what of the patients who had a severe, but chronic depression?

Dr. Thase notes that for this group of patients other approaches to treatment may be more effective than traditional cognitive therapy, particularly the cognitive behavioral analysis system of psychotherapy (CBASP) and other therapies specifically designed to treat patients with chronic depression.


Hollon  SD, DeRubeis  RJ, Fawcett  J,  et al.  Effect of cognitive therapy with antidepressant medications vs antidepressants alone on the rate of recovery in major depressive disorder: a randomized clinical trial.  JAMA Psychiatry. 2014;71(10):1157-1164.

Thase ME. Large-Scale Study Suggests Specific Indicators for Combined Cognitive Therapy and Pharmacotherapy in Major Depressive Disorder. JAMA Psychiatry. 2014;71(10):1101–1102. doi:10.1001/jamapsychiatry.2014.1524