Psychotherapy may be superior to medication when treating long-term depression

Psychotherapy may work better than medication in reducing the level of long-term depressive symptoms, according to study results published in Journal of Psychiatric Research.

“Patients who received any form of psychotherapy appeared to have a better long-term outcome than those who received antidepressants,” Roger T. MulderMB, ChB, PhD, FRANZCP, a professor of the department of psychological medicine at the University of Otago, Christchurch, New Zealand, and colleagues wrote.

In a follow-up of three randomized controlled trials conducted in New Zealand of patients treated for major depression, Mulder and colleagues looked at outcomes at 5 years to determine whether the patient's original treatment influenced the course of illness and whether baseline features or clinical characteristics influenced long-term outcomes of the depression. Of the 298 patients with follow-up data available at 5 years, 106 received medications as treatment, and 192 received psychotherapy. Mulder and colleagues used mood symptoms in the 2 years before the assessment as the a priori outcome.

Results showed more than half of patients reported no depressive symptoms in the 2 years before assessment. About one-third had fluctuating depression, and 12% had chronic depression. Researchers noted several outcome predictors, which included baseline severity, suicidality, personality pathology and treatment type. They emphasized that the presence of personality pathology, which predicted poor outcome, served as the most robust long-term outcome predictor. Patients who received medication had moderately worse outcomes, even after adjustment for higher depression severity, suicidality and personality pathology at baseline among these individuals.

Mulder and colleagues concluded that about half the patients treated for major depression will continue to suffer significant mood symptoms in the long term, and about 10% will remain chronically depressed.

“Psychotherapy may be superior to medication in reducing the level

of symptoms over the longer term,” Mulder and colleagues wrote. “However, studies or meta-analysis comparing drug treatment and psychotherapy need to be interpreted

with caution since the patient groups may not be the same.

“In the current study, patients enrolled in a drug study were more likely to be male, more severely depressed, more suicidal and had more personality pathology,” they added. “In addition, we were unable to control for other treatments the patients received over the 5 years.”