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Patients and caregivers

To Treat Depression: Therapy or Antidepressants?

man examining pill bottle

Every year, nearly 16 million Americans experience depression and seek medical treatment. This decision marks the beginning of an often stressful process of trying various medications to find the best treatment plan. Patients may have to fill out forms that include screening questions and/or may be asked to share intimate details. The diagnosis of depression often leaves patients with the choice between psychotherapy, medication or both.

For many patients, the way forward is uncertain. Deciding between different types of medical treatments can pose unique challenges to each person, and patients may rely on their doctor to steer them in a certain direction.

To understand the process of finding each individual a treatment plan that works for them, it’s important to understand the different types of depression treatments offered.

Psychotherapy or Antidepressants?

Psychotherapy, or talk therapy, is a treatment method used to help people living with a mental health condition such as depression.

Psychotherapy evidence-based treatments such as cognitive behavioral therapy (CBT) have become popular in the field.

CBT provides patients with tools to address harmful thoughts, emotions and behaviors. By giving patients social support and teaching them coping skills, this form of psychotherapy help people living with depression find relief.

On the other hand, antidepressant medications work by changing chemical signaling in the brain. Antidepressants may be effective for treating depression in some patients, but researchers are still not clear on how effective these drugs are in alleviating depressive symptoms.

The understanding of the effectiveness of both types of treatments is still evolving and researchers have dedicated studies to learning more about these treatments. A 2012 study that reviewed data from more than 100 prior trials and included 10,000 patients uncovered that both psychotherapy and antidepressants were equally effective. Even more interestingly, the study found that these forms of treatment were no more effective than alternative therapies, like exercise.

Since then, similar research has been conducted with many studies coming to the conclusion that both psychotherapies and medications are comparably effective in improving the quality of life for people living with depression.

Using Both Therapy and Medication

Knowing that both psychotherapy and medication are used to treat depression and often have the same level of effectiveness begs the question of whether the methods, if used together, would yield even greater results.

Since studies determining the effectiveness of each treatment have come to different conclusions, most patients receive either psychotherapy or medication.

In 2016, the American College of Physicians developed guidelines about using antidepressants instead of psychotherapy for depression treatment. A committee concluded that CBT and newer generation antidepressants have similar effectiveness in adults living with depression. The guidelines recommend clinicians offer patients the option of CBT or antidepressants when it comes to treating depression.

Doctors often prescribe antidepressants first to treat patients with depression. These medications can have side effects such as nausea and vomiting. Surveys show that more than 250 million antidepressant prescriptions are filled annually in the United States. According to a 2015 JAMA study, 13% of U.S. adults took antidepressants in 2012, which is almost double the amount since 1999.

Understanding that psychotherapy and antidepressants have the same level of effectiveness may help change this trend in depression treatment.

Are Antidepressants Overprescribed? 

Patients may prefer to take medication for their depression rather than work through psychotherapies like CBT. Some patients may not have a way to access a mental health specialist or have the time to talk to a therapist. There are also patients who may prefer to take a pill in their home rather than having a personal discussion with a clinician.

Another reason why antidepressants are commonly prescribed may be related to the structure of the U.S. healthcare system. Clinicians may lean towards medication treatment due to higher insurance reimbursements and the efficiency of quick check-ins rather than a series of in-depth discussions and therapy sessions.

Alternative Treatment Options

In addition to psychotherapy and medication, there are additional treatment options for depression. Exercise may help manage mild or moderate depression. Transcranial magnetic stimulation or electroconvulsive therapy can help patients with more severe depression.

Assessing Treatment Options

In today’s hurried medical environment, it can be challenging for clinicians to discuss treatment options, adverse effect profiles, cost and accessibility with a patient. However, it is critical to have a thorough and comprehensive conversation to help patients understand the scope of treatment for depression.

One option that can help guide clinicians in deciding on a treatment plan is pharmacogenetic (PGx) testing (think of it like genetic testing for depression medication). Genomind’s pharmacogenetic testing is performed via a cheek swab that looks that looks at key genes in an individual’s DNA that can affect how they respond to medication for depression. The test identifies patient-specific genetic markers that can indicate for clinicians:

  • Which medications may be more or less likely to be effective at relieving symptoms
  • Which medications may be more or less likely to produce side effects
  • How the patient metabolizes medications used to treat depression

This can help personalize treatment for the individual patient, based on their DNA. Find out more here.

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