As a psychiatrist with a practice located in West Los Angeles, between Santa Monica and Beverly Hills, I often see patients who require a variety of therapies. One common question involves the advantage of combining medication with psychotherapy.
Both antidepressants and psychotherapy can be effective for major depression or dysthymia, a chronic, low-level form of depression. One of the most fascinating findings is that both medication and psychotherapy produce similar changes in the brain of patients who respond to treatment. We don’t understand why, but it suggests that ultimately psychotherapy — which involves new learning— is working to change the underlying structure and function of the brain.
About two-thirds of all patients with major depression will improve on antidepressant medication alone, although only one-third will become symptom-free. In general, the longer you have been suffering from depression, the harder it is to achieve a full remission with just medication. How you were before you became depressed also matters: people with stable jobs and relationships tend to have an easier time of it than people who have struggled more or who have more stress in their lives. Combining medication with psychotherapy improves recovery rates by as much as 33% over medication alone, and seems to be particularly beneficial for people with more severe or more chronic depression, or for people who also have medical illnesses. On the other hand, there are some intriguing research results that suggest that for people with a history of childhood trauma (such as the early loss of a parent or physical or sexual abuse), therapy alone is more effective than medication, and receiving both together is not significantly better than psychotherapy alone.
The best-studied types of therapies for depression (and the ones most often combined with medication) are cognitive-behavioral therapy and interpersonal therapy, although we don’t know yet if one is better than the other, or if success is related to patient characteristics. These types of therapies are typically focused on improving symptoms rather than looking at unconscious patterns of behavior and increasing self-knowledge.
Ultimately the decision about which type of therapy and whether or not to take medication should be based on what the research literature says and your personal preference. There is almost always more than one right choice — the goal is to find the choice that most closely matches your needs and preferences and which is consistent with what the research literature suggests.
