Is Therapy or Medication Better For Depression?

In 2020, an estimated 66% of adults in the United States with a major depressive episode had received treatment within the last year.

The treatments most commonly used include antidepressant medication, psychotherapy, or a combination of both.

Antidepressants

It’s believed that antidepressants work by balancing your brain’s neurotransmitters, particularly serotonin, dopamine, and noradrenaline.

Research from 2020 suggests that antidepressants work best for moderate, severe, and chronic depression, but not necessarily for mild depression.

About half of all people with depression will respond to any given antidepressant, regardless of its class; however, one in three will not respond to the medication at all. Among the remaining individuals, most will eventually respond to another antidepressant or a combination of antidepressants.

Evidence shows that while antidepressants are effective at relieving symptoms, they don’t necessarily address the cause. So if you stop taking them, you still have an elevated risk of future episodes.

Psychotherapy

For many people, depression, at least partially, stems from negative thought patterns. During psychotherapy, you and your therapist will identify and challenge any thoughts and behaviors that are negatively impacting your life.

Psychotherapy is also a good option for people who prefer not to take medication or who don’t respond well to it.

Research findings: antidepressants vs therapy

In a 2005 study, 240 severely depressed participants were randomized to receive antidepressant therapy (paroxetine, augmented with lithium or desipramine as needed), cognitive therapy, or placebo.

At the 8-week assessment period, both cognitive therapy and antidepressant use outperformed placebo. At the end of the 16-week treatment phase, there were no differences in response rates between therapy and medication, with 58% of both treatment groups showing improvement.

After 16 weeks, remission rates were slightly better for the antidepressant group: Of those taking antidepressants, 46% reached remission, compared with 40% of the participants in therapy.

Another large analysis from 2019 found that antidepressant medication was slightly more effective than cognitive behavioral therapy (CBT) in reducing overall depression severity in people diagnosed with a depressive disorder.

Antidepressant medication outperformed CBT in reducing the following symptoms:

• depressed mood
• feelings of guilt
• suicidal thoughts
• mental anxiety
• general somatic symptoms

Some evidence suggests that combining psychotherapy and medication may be more effective than either treatment alone.

In a 2014 study, 452 adults with chronic or recurrent major depressive disorder were randomly assigned to one of two treatments: antidepressant medication alone or antidepressants combined with cognitive therapy. Treatment lasted for 42 months until recovery was achieved.

Overall, 72.6% of the participants who received combination therapy recovered, compared with 62.5% of those in the antidepressant-only group. Those with more severe symptoms of depression benefited even more from the combination treatment.

For instance, participants using a combination of therapy and medication had an 81% recovery rate compared to only 51% of participants using antidepressants alone.

In addition, those who were given combination therapy experienced fewer serious side effects compared to those taking only antidepressants.

The two most effective types of psychotherapies for depression include cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT).

CBT is the most widely-known and most rigorously tested of all types of psychotherapy.

CBT is based on the premise that inaccurate and harmful beliefs play a major role in causing depression. Correcting these dysfunctional thinking patterns can reduce both present and future depressive episodes. CBT focuses on thinking patterns and modifying behavior rather than exploring past experiences.

IPT is another good option for treating depression, especially if you believe your depression is related to your relationships (not just romantic). This therapy is a targeted short-term treatment (12-16 weeks) designed to improve mood symptoms by enhancing interpersonal functioning.

It’s based on the premise that depressive symptoms and relationship problems are often intertwined and constantly affecting each other.

Clinical trials suggest that when people successfully work through relationship problems— such as with a spouse, parent, child, or friend— their depressive symptoms also tend to diminish.

Regardless of the therapy you choose, it’s important to stick with it for a while to reap the benefits. Research suggests that about half (50%-60%) of people in therapy need at least 11 to 13 sessions to fully recover.

The most commonly used antidepressants for depression include the following:

• selective serotonin reuptake inhibitors (SSRIs)
• selective serotonin noradrenaline reuptake inhibitors (SNRIs)
• tricyclic antidepressants (TCAs)

Less commonly prescribed antidepressants include the following:

• selective noradrenaline reuptake inhibitors
• selective noradrenaline/dopamine reuptake inhibitors
• adrenergic alpha-2 receptor antagonists
• monoamine oxidase (MAO) inhibitors
• melatonin receptor agonists and serotonin 5-HT2C receptor antagonists

The pros of antidepressants:

• less expensive than therapy
• simple to do; involves no extra time
• regulates brain chemicals like serotonin and dopamine

Cons of antidepressant medication:

• may result in side effects
• may take 2-8 weeks to see a difference
• may take a few tries to get the right medication
• some people may develop suicidal thoughts, particularly young people
• may be difficult to stop taking, causing discontinuation symptoms

Psychotherapy and antidepressant medications are two key interventions for treating depression.

Each approach has successfully treated millions of people, and research has shown that they’re particularly effective when used together.

While it’s very important to make an informed choice and do your own research, be sure to consult with a doctor about which approach might be right for you.