Among the various psychotherapeutic "talk therapies," cognitive-behavioral therapy appears to be the most effective approach. If psychotherapy is used alone without medications, benefits should be evident within 8 weeks and symptoms should be fully resolved by 12 weeks. If these conditions are not met, then the patient should strongly consider antidepressant drugs.
Cognitive Behavioral Therapy
For many patients, cognitive behavioral therapy (CBT) works as well as antidepressants in treating severe depression. Like all psychotherapies, much of the success depends on the skill of the therapist. Many studies suggest that combining cognitive therapy with antidepressants offer the greatest benefits. Studies also indicate that the benefits of cognitive therapy persist after treatment has ended.
Best Candidates. Although helpful for all patients with depression, CBT may be particularly helpful for the following patients:
- Patients with atypical depression or dysthemia
- Patients with a history of suicidal behavior
- Adolescents with mild symptoms of major depression
- Women with non-psychotic postpartum depression
- Children of parents with the depression -- in this case, therapy should involve the whole family.
Approach. CBT focuses on identification of distorted perceptions that patients may have of the world and themselves, on changing these perceptions, and on discovering new patterns of actions and behavior. These perceptions, known as schemas, are negative assumptions developed in childhood that can precipitate and prolong depression. CBT works on the principle that these schemas can be recognized and altered, thereby changing the response and eliminating the depression.
Review Date: 01/27/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.