10 Top Questions About Antidepressants and Psychological Treatments

Medical Reviewer
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Do antidepressants work?

Antidepressant medications appear most effective when depression is very severe and there is fairly solid evidence to support their use in such circumstances. Success however depends on how we define the term. Many people continue to have residual symptoms and incomplete recovery following antidepressants and some people appear entirely resistant to the intended therapeutic effects.

Are some antidepressants better than others?

All antidepressants have broadly similar therapeutic outcomes. The key difference for most people is the level to which they can tolerate the side effects of a given antidepressant. The so-called new generation antidepressants have relatively fewer side effects and the worst of them tend to pass after a few weeks.

How long do antidepressants have to be taken?

Current guidelines suggest an absolute minimum of six months with a further six months preferred. For people with a history of recurrent depression treatment by antidepressant may be indefinite. 

Do psychological treatments for depression work?

The most researched of the psychological treatments for depression is cognitive behavioral therapy (CBT). The evidence states it is significantly more effective than no treatment, appears equal to medication in reducing depression in the acute phase, and is more effective than medication in the long-term prevention of relapse. 

What about the other types of psychological therapy?

Other types of psychological therapy may well be very effective in the hands of an experienced therapist. Issues such as time, cost and practicality have to be considered but often the main problem is how to measure and prove the effectiveness of certain psychological therapies. The issue is clouded further by the fact there are many forms of therapy, some of which overlap. 

How does CBT approach depression?

The CBT approach states the way we think (cognition), feel and behave all interact, but it is our thoughts that determine our feelings and behavior. So, negative, unrealistic or inaccurate thoughts cause distress because they skew the way in which we interpret situations.

So what is it about CBT that works?

It is the specific techniques that enable patients to break into the cycle of negative mood and negative thinking and to compensate by developing alternative ways of thinking and behaving, which reduces distress. It is a practical problem-solving approach that focuses on current problems rather than things from the past. 

Is there a down side to CBT?

It is a highly structured approach that doesn’t suit everyone and probably isn’t useful for people with complex mental health needs. Some people complain the focus on thinking and problem-solving is too narrow and doesn’t allow for broader expansion of issues that also contribute to depression. 

Where should I turn first: medication or psychological therapy?

See your doctor first. The symptoms of depression can be caused by various physical conditions and you need to rule these out. 

And if no physical problem shows up; what then?

Then you have a choice. Your doctor may recommend antidepressants or psychological therapy depending on your symptoms. Some experts believe combining both is superior to either in isolation, more especially if depression is severe. These days psychological therapies can be done online, over the telephone and even by email, so the choices are broader than ever.