Depression Therapy

A depression may have been around for so long that it began in childhood or adolescence. The original triggers are lost in time. Or they can be identified. A depression may be set off by by the onset of a particular stressor, often one where there has been a personal loss or a blow to self-esteem. After a loss, feelings of emptiness, grief, and abandonment can follow. After a blow to self-esteem, harsh self-criticism and feelings of failure can be experienced. The onsets of many depressive episodes have significant psychological components, such as just described. However, they also may have genetic roots, and, if so, other family members may have been depressed. Also, biology may be the primary trigger; for example, some women experience premenstrual, peripartum (during pregnancy or after delivery), or postmenopausal depressions (DSM-5). For Bipolar Disorders and other depressions that are mainly triggered by biology, medication is the primary treatment with psychotherapy being a useful addition.

However, most depressions are a combination of biology and psychology. For such depressions, what I have read has concluded that pharmacology and psychotherapy are both useful and complimentary when used together. One researcher at Oxford (Jacobson, 2013) had found that both psychotherapy and medication work to change negative emotions into more positive ones. Antidepressants seemed to make the shift toward positive processing well before an improvement in mood. Psychotherapy appeared to promote a corrective re-engagement with the outside world by translating the more positive processing into new cognitive and behavioral approaches to life. This researcher concluded that both treatment forms worked well in tandem. 

 Cuijpers (2024) with colleagues did a comprehensive look at more than  1ooo randomized treatment trials concerning depression and agreed that psychotherapy and antidepressant medications are the two most important therapeutics for depressive episodes. It was concluded that psychotherapy and antidepressant drugs have effects that are comparable in the short term and that they are better used together than alone. Yet when used alone, psychotherapy is significantly more effective than medication, especially in the long term. However, not everyone gets better with treatment.

Cuijpers (2024) found that 41%of patients initially have a positive response rate, defined by as 50% symptom reduction. Yet sequential treatments appear to increase effectiveness. With the addition of another form of therapy, there is a 65% response rate. About 80% respond after a third approach is added. For example, medication might be first, behavioral activation might be second, and a technique of talk therapy might be third.  Other methods also have impacts, such as direct feedback to patients. A higher frequency of sessions yield larger effects. That is, two sessions a week are better than one; one is more effective than once every two weeks. Newer psychotherapies have not shown themselves superior than older ones. It may be better to understand how to use what is already established than to spend time on learning something new that is no better.

Nevertheless, there are other considerations to weigh before deciding to use medication. Psychotherapy has fewer physical side effects and a lower frequency of relapse. Lu (2015) opined that mindful meditation, which is often used as a psychotherapy technique, may well be as effective in presenting relapse, if it is continued as a practice, as maintenance antidepressants. Moreover, since experiences can change the nervous system, psychotherapy can also impact the biology of depression.

Many in my field, including myself, share the opinion that psychotherapy is the primary treatment of choice for predominantly psychologically-based clinical depressions. Only psychotherapy can bring about fundamental changes in outlook, self-image, and behaviors as well as more self-awareness and self-agency. In the long run, these are the changes that increase resilience and decrease the vulnerability to depression. These are the changes that help reduce relapse rate. These are the changes that drive the therapeutic work.