Therapy or Meds for Depression?

by Leonard Holmes, Ph.D.

Should you take a medication to treat your depression? Should you get into therapy? More antidepressants are prescribed by family practitioners than by psychiatrists. These medications are often the first treatment offered to people who are depressed. Managed care companies in the U.S. like this approach because antidepressant medications are less expensive than psychotherapy.

Numerous studies have come to similar conclusions about effectiveness. Cognitive-behavioral psychotherapy and antidepressant medication are equally effective. Combined psychotherapy with medication are also more effective than medications, but some studies suggest that the combination is no more effective than psychotherapy alone. Studies also suggest that the relapse rate is higher among depressives treated with combined treatment than with just psychotherapy.

Many studies have found a higher dropout rate among those receiving medication, either because of side effects or because the medication has not helped.

Providers of health care and mental health care tend to use the tools that they are trained to use. This can sometimes create problems. A saying attributed to different people (including Milton Erickson, M.D.) says it best: "If the only tool you have is a hammer you tend to treat everything like a nail." It may be no coincidence that the authors of the studies cited here are psychologists. Psychologists are able to provide psychotherapy but not medications. It's also no coincidence that most primary care physicians prescribe antidepressant medications before they refer for counseling or psychotherapy. They have a prescription pad handy - but they do not have much time to spend talking with their patient. We tend to use the tools that we have.

Studies agree that both antidepressants and psychotherapy are effective treatments for depression. There is even agreement that a combination of the two may be more effective than either alone. It may well be that one treatment is likely to be more effective than the other for a particular person. The art and science of mental health are not yet refined enough to be able to predict which treatment will be more effective for a given person.

If you are depressed keep these principles in mind. The practitioner that you are seeing may have only certain tools available to him or her. Their recommendation for treatment may have more to do with their training than with any particular knowledge of your situation. The most important point may be that there are a variety of treatments that are effective for depression. It may not matter which treatment your doctor or therapist offers first. If it doesn't work, ask him or her about alternatives.