About 1 in 5 adults in the United States suffers one or more depressive episodes over a lifetime, according to the National Institute of Mental Health. Depression is a serious, disabling illness. It affects an individual’s ability to work, study, sleep, eat and enjoy activities once found pleasurable. Depression can be treated with psychotherapy or medication or both. But only 40% of people are helped by initial treatment, whether drugs or talk therapy, and pinpointing the best treatment or combination for a patient can take weeks. Now the findings in two new studies can help identify the right treatment and speed relief. “This research has provided us valuable information,” says Douglas Baum, L.C.S.W. and specialist in depressive disorders with The Morris Psychological Group of Parsippany, N.J. “One study confirms that psychotherapy – with or without medication – not only helps people with depression, but the benefit is consistent for the many different types of talk therapy. The second study shows that we soon may be able to identify which patients are most likely to respond to psychotherapy and which might do better on medication. The sooner we can get patients into the best form of treatment the sooner we can ease their depression.”
Depression is a disorder of the brain. Brain-imaging technologies used on individuals with depression show changes in the parts of the brain that affect mood, behavior, thinking, sleep and appetite. “We can see changes in the brain but we don’t know what causes them,” says Mr. Baum. “There is a range of factors – biological, genetic, psychological and environmental – that combine in different ways in different people to contribute to depression.” Major depression, also known as clinical depression, is distinguished by its duration and intensity from the feelings of sadness that affect everyone at times. It is characterized by feelings of worthlessness, hopelessness and guilt; fatigue and loss of energy; inability to concentrate; insomnia or excessive sleeping; and diminished interest in once-pleasurable activities.
In a study published in May in PLOS Medicine, researchers at the University of Bern in Switzerland examined almost 200 clinical trials that assessed seven different types of psychotherapy in treating major depression in more than 15,000 patients. “The first conclusion of this study confirms what we have long known,” says Mr. Baum. “Psychotherapy, sometimes known as talk therapy, delivers a ‘moderate to large’ benefit in treating major depression. The second conclusion is that there is no one type of therapy that is best for everyone. So a patient’s choice of therapy can be based on individual factors, such as the nature of the illness, the patient’s comfort level with a therapist and practical matters such as duration of the therapy and financial considerations.”
There is a wide range of psychotherapies used to treat depression. Among the most common are cognitive behavioral therapy, which is a short-term, structured approach that focuses on correcting negative thoughts and dysfunctional behaviors; interpersonal therapy, also short-term, which tries to improve the patient’s interpersonal relationships and social skills; psychodynamic therapy, which examines how past experiences and unresolved conflicts are affecting the patient today; and supportive therapy, a longer-term approach in which the therapist offers empathy and support but does not suggest solutions or teach new skills. “There’s a fair amount of overlap in these therapeutic approaches,” says Mr. Baum. “The good news that can be drawn from this study is that they all work and patients can confidently choose the therapy that best meets their needs.”
In the second study, published in JAMA Psychiatry in June, researchers at Emory University found that PET scans that identify activity in different parts of the brain could help determine which patients are likely to respond more quickly to psychotherapy and which to medication. “This is preliminary research,” says Mr. Baum, “and a lot more work has to be done. But there is the potential to use scans to guide decisions about initial treatment and eliminate the trial and error that often delays relief for the patient.”
“One of these studies confirms the importance of psychotherapy in treating depression,” Mr. Baum concludes, “and the other begins to move the needle toward determining biologically what will work best for each patient. Both reinforce our understanding that different solutions work for different people. The sooner we can match patient to treatment with a high degree of precision, the sooner we can relieve patients of the pain of depression.”
