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Counseling or Antidepressants for Treating Depression?

Counseling or Antidepressants for Treating Depression?

In adults with depression, is treatment with antidepressants more effective than counseling?

Both antidepressant medications and psychologic treatment are beneficial for adult patients with mild to moderate depression, with no consistent evidence that one type of treatment is more effective than the other.

There is limited evidence that antidepressant medications and cognitive behavioral therapy are similarly effective for patients with severe depression

Evidence Summary

By 2020, depression is expected to be the second most common cause of disability worldwide.1 Current numbers show that major depression will affect 4.9 to 17.9 percent of U.S. residents sometime during their lifetimes; 20 to 30 percent of this group will experience a chronic, relapsing course.2 Ninety percent of depression is treated by primary care physicians.3 For adults with mild to moderate depression, there is no direct evidence that drug or nondrug therapy is superior. Prescription antidepressants are effective at all levels of severity, but systematic reviews have shown no differences in outcomes between any classes of antidepressants.4 Different types of psychotherapy (including cognitive therapy and interpersonal psychotherapy) are also effective for managing mild to moderate depression.1 However, consistent evidence is lacking to make a statement about the relative effectiveness of different types of psychotherapies compared with each other or with drug treatment. One RCT5 comparing nefazodone (Serzone, removed from the U.S. market in May 2004 because of hepatotoxicity) with cognitive behavioral therapy over a 12-week period demonstrated similar effectiveness for each treatment alone. Another RCT6 of 240 outpatients with moderate to severe depression compared the effectiveness of paroxetine (Paxil) and other medications with cognitive behavioral therapy. Both treatment types were found to be effective, but the degree of effectiveness for cognitive behavioral therapy was dependent on therapist experience, and the overall number of patients in the therapy group was small (n = 60).6

SOURCE:- Spencer, Donald C; Nashelsky, Joan (American Family Physician)
Updated: Dec 21st 2005

SOURCE:- Spencer, Donald C; Nashelsky, Joan (American Family Physician)
Updated: Dec 21st 2005

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