A finding to feel good about
For people who are depressed, there is no right—or wrong—answer when it comes to choosing between psychotherapy and medication. That's the primary finding of a new paper coauthored by Margit Berman, Ph.D., a Dartmouth psychologist.
Meds: "I always remind my patients that they are not average," Berman says, "that there is no average person." Certain individuals may prefer therapy or medication. But, in general, she says, "there is no research to suggest that either antidepressant medication or psychotherapy or the combination of meds and therapy is better."
To reach this conclusion, Berman and her coauthors at Minnesota's Metropolitan State University analyzed 15 already published studies, an approach known as a meta-analysis. Their analysis was the first to include only research that compared psychotherapy to second-generation antidepressants—without muddying the waters with older drugs that are now rarely used. Second-generation antidepressants include selective serotonin reuptake inhibitors like Prozac and serotonin and norepinephrine reuptake inhibitors like Cymbalta.
Berman's study, which was published in the Journal of Nervous and Mental Disease, also distinguished what she calls "bona fide psychotherapy" from psychotherapy lacking a clear evidence base or a skilled practitioner. To be considered bona fide, the therapist had to have at least a master's degree or be in graduate school in a relevant field; the therapy had to be delivered face-to-face and be individualized to the patient; and the therapy had to be evidence-based.
Many doctors believe that only specialized therapies, such as cognitive behavioral therapy, are as effective as medications, she explains, but practitioners of those therapies can be hard to find in many communities. "Actually, any good therapy helps," she says, noting that patients don't need to seek out a particular type of therapist.
Depression: Psychiatrists have great faith in antidepressants, "just as I have great faith in psychotherapy," she adds. "We all like what we do." And now patients with depression—and their doctors—can feel good about trying either approach.
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