In a society where healthcare is the best it’s ever been, where we have access to more resources, education, support – you name it – rates of depression are rising. In the UK alone, between 2017 and 2018 rates of depression rose by almost 1% (1, 2). In real terms, that’s 560,000 people. A hell of a lot. This new data doesn’t necessarily mean that people are more depressed. Yes, that is one explanation, but you also have to account for positive changes such as increased awareness and decreased stigma encouraging people to seek help. There is another discussion running parallel to this, however, a redundant one. One that dictates, and itself stigmatises what help we should seek: should we medicate or should we talk? In the battle for this Iron Throne, there are no winners.


Drugs vs Words

Drug therapy is perhaps the most well-known and recognised treatment of depression to the average person. It is also the most stigmatised. Who can blame them when pharmaceuticals are constantly all over the news, all over the forums, and dominate conversations about depression?

What if I told you that there was a treatment for depression with the same success rates as antidepressant drugs?

That, unlike the litany of side effects from those, this treatment has none?

Well, now I’m going to tell you that such a treatment actually exists and it’s name is psychotherapy. It’s been known for a while that talking therapies and antidepressants have the same rates of success (rates of relapse are less well studied). A systematic review and meta-analysis of randomised controlled trials of antidepressants and psychotherapy – in this case CBT – was published in 2015 (3) that showed this definitively. CBT lends itself well to research as it is short-term and incredibly structured (if you look at self-help books, you can even say standardised). This does not mean that it is the best or the most useful, just that it has been the most looked at. Other types of therapy include interpersonal therapy, psychodynamic (or psychoanalytic) therapy, or some combination of them all.

Talking vs….Other Types of Talking

These other types of therapy are now becoming as studied as CBT, as it comes under fire due to studies using low quality evidence, weak empirical comparisons, researcher bias, and limited efficacy. For example, there is a currently a trial underway exploring the efficacy of hypnotherapy and hypnosis as therapeutic adjuncts in depression (4). Another recent systematic review showed equivalence between psychodynamic/psychoanalytic therapy and other forms of CBT-based psychotherapies (5).

Our understanding of depression and its treatment is very much in its infancy (we don’t even know what causes depression – inflammation? neurotransmitter imbalance?). What we do know, however, is that a combination of talking therapies and antidepressant medication has been shown to have better effects than either treatment alone (6). It is not a case of drugs vs talking. Nor is it a case of having to participate in one type of talking therapy either. There is no rule book here and nothing to say (rather the opposite if you ask me) that a multi-pronged approach wont work better. In medicine, we are increasingly aware that individual variation is huge and what works well for one person, might not work well for another and vice versa. Hence the dawn of new fields such as nutrigenomics, and the advent of an era of personalised medicine.

It’s 2019 people, bottling up emotions and experiences is no longer in vogue. Embrace health, embrace life. Do this by seeking treatments that work for you, exploring treatment options – if one approach doesn’t work, don’t give up. Try another!

Sources:

1.Bostock N. Depression rising faster than any other condition measured in QOF | GPonline [Internet]. Gponline.com. 2018 [cited 15 May 2019]. Available from: https://www.gponline.com/depression-rising-faster-condition-measured-qof/article/1497552

2. Mental health statistics: depression [Internet]. Mental Health Foundation. 2019 [cited 15 May 2019]. Available from: https://www.mentalhealth.org.uk/statistics/mental-health-statistics-depression

3. Amick H, Gartlehner G, Gaynes B, Forneris C, Asher G, Morgan L et al. Comparative benefits and harms of second generation antidepressants and cognitive behavioral therapies in initial treatment of major depressive disorder: systematic review and meta-analysis. BMJ [Internet]. 2015;351(8037):h6019. Available from: https://www.bmj.com/content/351/bmj.h6019

4. Fuhr K, Schweizer C, Meisner C, Batra A. Efficacy of hypnotherapy compared to cognitive-behavioural therapy for mild-to-moderate depression: study protocol of a randomised-controlled rater-blind trial (WIKI-D). BMJ. 2017;.

5. Steinert C, Munder T, Rabung S, Hoyer J, Leichsenring F. Psychodynamic Therapy: As Efficacious as Other Empirically Supported Treatments? A Meta-Analysis Testing Equivalence of Outcomes. American Journal of Psychiatry. 2017;174(10):943-953.

6. Hollon S, DeRubeis R, Fawcett J, Amsterdam J, Shelton R, Zajecka J et al. Effect of Cognitive Therapy With Antidepressant Medications vs Antidepressants Alone on the Rate of Recovery in Major Depressive Disorder. JAMA Psychiatry. 2014;71(10):1157.

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