On Wed, 27 Dec 2000 16:36:16 EST, [EMAIL PROTECTED] wrote:
>Need some information concerning the following:
>
>1) Recent studies comparing psychotherapy with medication as treatment for
>depression. I was under the impression that psychotherapy is not really an
>effective treatment for moderate to severe treatment - at least not by
>itself. Someone claimed otherwise to me - that psychotherapy is as good if
>not better than medication. Can anyone support this for me, or enlighten me
>if I am wrong?
I just came across this reference which may have a good bit of what you
want. I have not read it,
Nathan, P.E., Stuart, S.P., & Dolan, S.L. (2000). Research on
psychotherapy efficacy and effectiveness: Between scylla and charybdis?
Psychological Bulletin, 126:6 Special Issue.
I may have other recent paper which will help, but I haven't had time
to run them down. If I do, I'll send the references to you. However, my
working presumptions are as follows: Cognitive behavioral therapy is
highly effective for mild, moderate, and severe depression. I have
worked quickly and effectively with individuals for whom their
psychiatrists had given up on medications and were ready to begin
electroshock therapy. Medications appear, at least for numerous people
I have seen, to be much less effective than they are touted to be
(people seek psychological therapy after having been on medications for
years with little benefit). Medications often cause more problems than
they solve and this effect tends to be vigorously denied by the doctors
prescribing the medications. This is true for both antidepressants and
stimulants for attention problems.
My working presumptions are based on my reading of the literature and
my direct experiences as a therapist in independent practice for 20
years. I essentially gave up recommending medications 10 or 12 years
ago for a couple of reasons, the main one of which was a pure
psychological approach is highly effective and uncomplication by side
effects and misinformation by well-meaning, but ill-trained and
inexperienced medical doctors. Medications always complicate my work,
mainly because people sit back and wait for the medicines to cure their
problems (as typically recommended by the prescribing physician), when
it doesn't work that way they often consider themselves untreatable,
thinking "medication must be more effective than psychology."
I regularly review clinical news letters and scan the literature
extensively most weeks. I know of know papers which show medicines to
be more effective than cognitive-behavioral therapy, Most studies don't
even compare the two. When the methods are compared the typical result
for depression and anxiety disorders is equal efficacy with a definite
edge for psychological work in reducing relapses. Studies seem to show
that the two methods are equally effective in alleviating a depression,
but that only the psychological therapy confers resilience, that is,
after medication treatment patients are just as likely as before
treatment to become depressed again. However, after
cognitive-behavioral therapy they are much less likely to have a
recurrence of depression.
Recent studies with the best controls clearly suggest that Prozac has
no more than a placebo effect. I always keep in mind, a medical
intervention is never purely medical; it is both medication and
psychological because if people believe the medication will work then
the size of the placebo effect increases to an important extent.
The research comparing the two approaches tends to be rather
complicated to interpret. There is a very high drop out rate in
medication studies because people have a high rate of physical and
emotional side effects which they dislike. Thus, the patients who
complete medication studies tend not to be the same ones who complete
psychological studies.
Other factors need to be considered in evaluating the relative efficacy
of the two approaches. Greatly reduced sexual desire is a rather
frequent side effect of medications, but not psychological treatments.
Many patients, properly informed (usually they are not), would seek
psychological interventions and maintain sexual function even if, and
this is probably not actually true, psychological approaches were
somewhat less effective that pure medication approaches.
I recommend reading materials by Peter Breggin, MD on the matter. He is
inclined to promote psychological approaches over medication
approaches. Try his "Talking back to Prozac," 1994, available in paper
back. Also read material by David D. Burns, M.D, e.g. The Feeling Good
Handbook (1990; paperback) and "Feeling Good: The new mood therapy
(1980; paperback). Aaron Beck, another M.D., called the father of
cognitive therapy, promotes psychological approaches as does Albert
Ellis, PhD. While I do not doubt that the very best psychological
materials are written by psychologists, some are surprised in this day
and age that there are MDs who are major proponents of psychological
therapies despite their ability to prescribe medications.
A recent article in the APA Monitor is relevant: Chamberlin, J.
(October 2000). An historic meeting of the minds. Monitor on
Psychology, 31(9), 23.
I hope this helps. I'll try to run down some specific studies. I'm a
bit swamped right now.
Bruce L. Bachelder, PhD
Psychologist in independent practice
Morganton, NC
