A 2015 study found that non-pharmacological treatments for depression are just as effective as drug alternatives. Antidepressants also pose more serious adverse health risks than their drug-free alternatives.
For the sixteen million American adults diagnosed with depressive disorder—about 7% of the entire adult population—the first treatment is a prescription drug, according to studies conducted by the National Institute of Mental Health. Researchers at the Agency for Healthcare Research and Quality (AHRQ), a federally funded agency, compiled the findings of 44 different depression drug trials published within the past 25 years in order to determine the effectiveness of antidepressants compared to non-pharmacological treatments. They found no significant differences between the efficacy of antidepressant drugs and cognitive-behavioral therapy (CBT), a widely practiced treatment modality.
Researchers also found that patients treated with antidepressants were more likely to experience and discontinue treatment due to adverse side effects.
The majority of adults suffering from depression seek help from their primary care providers first, who more commonly prescribe antidepressants than psychiatrists, according to a 2008 study that appeared in the Journal of Clinical Psychiatry. Four out of every 10 patients treated with antidepressants do not respond favorably to the treatment and seven in 10 do not see any reduction of symptoms. For these patients, the second course of action is often different combinations of drugs and, more rarely, referrals to psychologists and social workers for therapeutic treatment.
Common side effects of antidepressants include, but are not limited to: gastrointestinal problems, sexual disorders, seizures, weight gain, confusion, fatigue, and an increase in suicidal ideation and behavior.
Researchers at AHRQ compared the risks experienced by patients who are prescribed antidepressant drugs to those participating in evidence-based, non-pharmacological treatments. They only included randomized control studies that met strict validity requirements in their meta-analysis, and categorized each study’s findings as being either in favor of antidepressants or in favor of any other treatments. They also weighted each study’s findings as “strong,” “moderate” or “weak.”
One non-pharmacological treatment in particular demonstrated comparable effectiveness to antidepressants with significantly fewer adverse health risks: cognitive-behavioral therapy, or more commonly, CBT. First popularized in the 1980s by psychiatrist Aaron T. Beck, CBT works with patients to identify unhealthy “automatic thoughts” and the self-destructive behaviors and emotions they elicit.
This meta-analytic study is one of the first government-funded studies to tackle the contested effectiveness of psychotropic drugs. In 2008, Harvard Medical School psychologist Irving Kirsch first brought this question to media attention after finding that antidepressants were just as effective as placebos in clinical trials. In response to criticism, Kirsch wrote, “most meta-analyses suffer from publication bias, which can happen when pharmaceutical companies withhold unsuccessful trials from publication.”
The AHRQ study moves in a new direction by comparing drugs to other types of treatment for depression and not just placebo. Researchers decided to exclude any placebo trials from this study.
Ultimately, the study suggests that both pharmacological and non-pharmacological treatment options should be presented to a newly diagnosed patient. These findings are consistent with the current medical standard.
“Our results are partially consistent with the recommendations of both the American Psychiatric Association and the Department of Veterans Affairs/Department of Defense,” the study reads.
“These consider both pharmacotherapy and psychotherapy to be appropriate individual first-step treatments for patients with mild to moderate [depressive disorder].”
Contrary to current practice, however, is their finding that CBT is an effective first-step treatment even for severe cases of depression. The authors stress that successful treatment decisions are made between a medical professional and an informed patient aware of all his or her options.
Before arriving at the University of Pennsylvania, Joshua Lin was a college access counselor at a traditional public school in Harlem, New York. He is currently an intern at Research for Action, a Philadelphia-based educational policy research organization, where he is assisting a project that is evaluating the impact of outcomes-based funding in higher education.
This story has been published in partnership with the University of Pennsylvania’s School of Social Policy & Practice (SP2). In the run up to the 2016 Presidential Election, the school launched “SP2 Penn Top 10, a comprehensive multimedia initiative in which renowned SP2 faculty members analyze and address the most pressing social justice and policy issues.”
Part of the project, is the creation of stories produced by “SP2 Penn Top 10 Fellows,” graduate students from the School who are trained in solution-based journalism using the Journalism for Social Change curriculum.